| Consultation Services Of Central New York - Medicine Provider, Pllc | |
|
7030 E Genesee St Suite 109 Fayetteville NY 13066-1121 | |
| (315) 560-6919 | |
| Not Available |
| Full Name | Consultation Services Of Central New York - Medicine Provider, Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 7030 E Genesee St, Fayetteville, New York |
| Authorized Official Name and Position | Matthew Henry Rosa (OWNER) |
| Authorized Official Contact | 3155606919 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Consultation Services Of Central New York - Medicine Provider, Pllc 7030 E Genesee St Suite 109 Fayetteville NY 13066-1121 Ph: (315) 560-6919 | Consultation Services Of Central New York - Medicine Provider, Pllc 7030 E Genesee St Suite 109 Fayetteville NY 13066-1121 Ph: (315) 560-6919 |
| NPI Number | 1205089992 |
|---|---|
| Provider Enumeration Date | 10/28/2008 |
| Last Update Date | 10/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205089992 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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