Provider Demographics
NPI:1699708123
Name:CAYUGA COUNTY
Entity type:Organization
Organization Name:CAYUGA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR TO THE CSB
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BIZZARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-253-0341
Mailing Address - Street 1:146 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1831
Mailing Address - Country:US
Mailing Address - Phone:315-253-0341
Mailing Address - Fax:315-253-1687
Practice Address - Street 1:146 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1831
Practice Address - Country:US
Practice Address - Phone:315-253-0341
Practice Address - Fax:315-253-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7240100A261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357268Medicaid
NY53174AMedicare PIN