Provider Demographics
NPI:1972716249
Name:CAYUGA COUNTY HEALTH DEPARTMENT-EISC
Entity type:Organization
Organization Name:CAYUGA COUNTY HEALTH DEPARTMENT-EISC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-253-1447
Mailing Address - Street 1:8 DILL ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3606
Mailing Address - Country:US
Mailing Address - Phone:315-253-1560
Mailing Address - Fax:315-253-1156
Practice Address - Street 1:8 DILL ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3606
Practice Address - Country:US
Practice Address - Phone:315-253-1560
Practice Address - Fax:315-253-1156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CAYUGA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03001058Medicaid