Basic Information
| Provider Information | |||||||||
| NPI: | 1699036475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2554 PERRY HWY | ||||||||
| Address2: | |||||||||
| City: | CLARKS MILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161142320 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 E ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154645540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2012 | ||||||||
| LastUpdateDate: | 06/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 0173491 | NY | N | Hospital Units | Medicare Defined Swing Bed Unit | 282N00000X | 0173491 | NY | Y | Hospitals | General Acute Care Hospital | 282N00000X | OCO11922 | PA | N | Hospitals | General Acute Care Hospital |
No ID Information.