Active NPI
Cynthia M Marino, PA
- Psychiatric/Mental Health Clinical Nurse Specialist
- Canandaigua, NY
National Provider Identifier
1982683934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Clinical Nurse Specialist
- License
- 002173
- Practice address
- 3200 West St
Canandaigua, NY 14424-1722 - Phone
- (585) 905-0061
- NPI assigned
- Jan 10, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0808X | 002173 | NY | Primary |
| Medical Physician Assistant | 363AM0700X | 002173 | NY |
Addresses
Primary practice location
3200 West St
Canandaigua, NY 14424-1722
Mailing address
3200 West St
Canandaigua, NY 14424-1722
Phone (585) 905-0061
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0107647 | Other | NY | INDEPENDENT HEALTH |
| 000570164004 | Other | NY | COMMUNITY BLUE |
Other names 1
- Cynthia M Ellis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care of Western New York, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community Based Hospice Care Agency
- Allegany, NY
- NPI 1275523482
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578614400000",
"number": "1982683934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 WEST ST",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241722",
"telephone_number": "585-905-0061",
"fax_number": "585-412-6612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 WEST ST",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241722",
"telephone_number": "585-905-0061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARINO",
"first_name": "CYNTHIA",
"middle_name": "M",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-10",
"last_updated": "2020-01-10",
"certification_date": "2020-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "364SP0808X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
"state": "NY",
"license": "002173",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "002173",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT HEALTH",
"identifier": "0107647",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY BLUE",
"identifier": "000570164004",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CYNTHIA",
"last_name": "ELLIS",
"middle_name": "M",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Canandaigua, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.