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Organization
WEST CAYUGA MEDICINE PC
Active
Organization
WEST CAYUGA MEDICINE PC
Active
Other names
West Cayuga Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
FABIAN A VENGOECHEA (OWNER & CEO)
(267) 368-6953
Entity
Organization
Contact information
Practice address
257 W CAYUGA ST, PHILADELPHIA, PA 19140-2439
(267) 368-6953
(215) 621-6940
Mailing address
257 W CAYUGA ST, PHILADELPHIA, PA 19140-2439
(267) 368-6953
(215) 621-6940
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103229169
—
PA
Enumeration date
10/27/2016
Last updated
03/21/2024
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