Basic Information
| Provider Information | |||||||||
| NPI: | 1174810980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TENEYCK | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 BRITTONFIELD PKWY | ||||||||
| Address2: | PO BOX 2000 | ||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130579226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153625129 | ||||||||
| FaxNumber: | 3153625179 | ||||||||
| Practice Location | |||||||||
| Address1: | 736 IRVING AVE | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154707828 | ||||||||
| FaxNumber: | 3154705811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2011 | ||||||||
| LastUpdateDate: | 06/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 563718 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.