Provider Demographics
NPI:1962422733
Name:CAYUGA MEDICAL CENTER AT ITHACA
Entity type:Organization
Organization Name:CAYUGA MEDICAL CENTER AT ITHACA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-274-4011
Mailing Address - Street 1:101 DATES DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1342
Mailing Address - Country:US
Mailing Address - Phone:607-274-4011
Mailing Address - Fax:
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1342
Practice Address - Country:US
Practice Address - Phone:607-274-4011
Practice Address - Fax:607-274-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5401001H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5401001HOtherNYS PROVIDER/OPER CERT #
NY00332729Medicaid
NYN49651OtherHEALTHNET CLIN LAB
NYNY7693OtherHEALTHNET HOSP URG CARE
NY925405OtherCONNECTICARE
NY284215OtherHEALTHLINK
NY7300101OtherOPTIMUM CHOICE
NYNY0101OtherJOHN DEERE
NY00011438301OtherUNIVERA PROVIDER NO
NY7516OtherTOTAL CARE EMERGENCY
NY900266OtherHARVARD PILGRIM HOSP ED
NY365593OtherMVP PROVIDER NO
NY7051OtherTOTAL CARE CLINIC
NY908422OtherHARVARD PILGRIM URG CARE
NY7051OtherTOTAL CARE URG
NY=========003OtherCHAMPUS PROVIDER NO
NYN49651OtherHEALTHNET CLIN LAB
NY908422OtherHARVARD PILGRIM URG CARE
NY7051OtherTOTAL CARE CLINIC
NYNY7693OtherHEALTHNET HOSP URG CARE