1952433757 NPI number — WESTERN NEW YORK BLOODCARE, INC.

Table of content: (NPI 1952433757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952433757 NPI number — WESTERN NEW YORK BLOODCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN NEW YORK BLOODCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEMOPHILIA CENTER OF WESTERN NEW YORK, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952433757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 MAIN ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14202-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-896-2470
Provider Business Mailing Address Fax Number:
716-218-4010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 MAIN ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14202-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-896-2470
Provider Business Practice Location Address Fax Number:
716-218-4010
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REGER
Authorized Official First Name:
LAUREL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
716-896-2470

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1401203R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X , with the licence number: 031796 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00011181601 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00474864 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000502000 . This is a "BLUE CROSSBLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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