1548315401 NPI number — ROSWELL PARK CANCER INSTITUTE

Table of content: MRS. AMANDA RENEE ZIMMER DENTAL HYGIENIST (NPI 1972031938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548315401 NPI number — ROSWELL PARK CANCER INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSWELL PARK CANCER INSTITUTE
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:
Provider Other Organization Name Type Code:
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:
1548315401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ELM AND CARLTON ST
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:
14263-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-845-2300
Provider Business Mailing Address Fax Number:
716-845-8386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ELM AND CARLTON ST
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:
14263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-845-2300
Provider Business Practice Location Address Fax Number:
716-845-8386
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
CANDACE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
716-845-5772

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  1401010H , 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)

  • Identifier: 00354518 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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