1295790939 NPI number — WESTERN NEW YORK ORTHOTIC SUPPLY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295790939 NPI number — WESTERN NEW YORK ORTHOTIC SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN NEW YORK ORTHOTIC SUPPLY, 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:
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:
1295790939
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:
1275 DELAWARE AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14209-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-881-0499
Provider Business Mailing Address Fax Number:
716-884-1128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 DELAWARE AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14209-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-881-0499
Provider Business Practice Location Address Fax Number:
716-884-1128
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALABRESE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-881-0499

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , 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: 8211684 . This is a "INDEPENDENT HEALTH ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00030137201 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00030137201 . This is a "UNIVERA COMMUNITY HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 080885 . This is a "NORTHWOOD PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00030137201 . This is a "UNIVERA HEALTHCARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02066315 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040401000197 . This is a "FIDELIS PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N7A , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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