Organization
CAYUGA MEDICAL CENTER AT ITHACA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA GOULD (CFO)
(607) 274-4011
Entity
Organization
Contact information
Practice address
101 DATES DR, ITHACA, NY 14850-1342
(607) 274-4011
(607) 274-4527
Mailing address
101 DATES DR, ITHACA, NY 14850-1342
(607) 274-4011
(607) 274-4527
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
7247020
NY
273R00000X
Psychiatric Hospital Unit
Primary
7247021
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00332729
—
NY
01
—
33S307
BLUE CROSS - PSYCH
NY
01
—
365593
MVP PROVIDER NO
NY
01
—
5401001H
NYS PROVIDER OPER CERT #
NY
Enumeration date
11/28/2006
Last updated
04/16/2025
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