Organization Active NPI

Central New York Medical Practice, PLLC

  • Clinical Psychologist
  • Syracuse, NY
National Provider Identifier
1962765016
Registry record updated Nov 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CENTRAL NEW YORK MEDICAL PRACTICE, PLLC
Practice address
600 E Genesee St
Syracuse, NY 13202-3130
Phone
(315) 464-3157
NPI assigned
Jun 22, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Myers, PHD
Title
Executive Director
Phone
(315) 798-4040

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

600 E Genesee St
Syracuse, NY 13202-3130

Mailing address

1601 Armory Dr
Building C
Utica, NY 13501-5405
Phone (315) 797-6241

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352678400000",
    "number": "1962765016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 ARMORY DR",
            "address_2": "BUILDING C",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135015405",
            "telephone_number": "315-797-6241",
            "fax_number": "315-749-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E GENESEE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023130",
            "telephone_number": "315-464-3157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL NEW YORK MEDICAL PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-22",
        "last_updated": "2012-11-12",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-798-4040",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.