Provider Demographics
NPI:1184284580
Name:CENTRAL NEW YORK ORTHOPEDICS LLP
Entity type:Organization
Organization Name:CENTRAL NEW YORK ORTHOPEDICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-735-4496
Mailing Address - Street 1:4401 MIDDLE SETTLEMENT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5332
Mailing Address - Country:US
Mailing Address - Phone:315-735-4496
Mailing Address - Fax:
Practice Address - Street 1:4401 MIDDLE SETTLEMENT RD STE 102
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5332
Practice Address - Country:US
Practice Address - Phone:315-735-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty