1306356340 NPI number — NEIGHBORHOOD HEALTH CENTER OF WNY, INC.

Table of content: (NPI 1306356340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306356340 NPI number — NEIGHBORHOOD HEALTH CENTER OF WNY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORHOOD HEALTH CENTER OF WNY, 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:
PHARMACY AT BLASDELL
Provider Other Organization Name Type Code:
3
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:
1306356340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4233 LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLASDELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14219-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-332-3380
Provider Business Mailing Address Fax Number:
716-332-3085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4233 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLASDELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14219-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-332-3380
Provider Business Practice Location Address Fax Number:
716-332-3085
Provider Enumeration Date:
10/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HAEFNERFNP
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
716-875-2904

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  035642 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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