1336635010 NPI number — UCPA OF NIAGARA COUNTY, INC.

Table of content: (NPI 1336635010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336635010 NPI number — UCPA OF NIAGARA COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCPA OF NIAGARA COUNTY, 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:
6
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:
1336635010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9812 LOCKPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14304-1197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-297-0798
Provider Business Mailing Address Fax Number:
716-297-0998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9812 LOCKPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14304-1197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-297-0798
Provider Business Practice Location Address Fax Number:
716-297-0998
Provider Enumeration Date:
07/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MANGUS
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUDGET MANAGER
Authorized Official Telephone Number:
716-297-0798

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02731946 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073667176 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669526745 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871647974 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02252757 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1124459383 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1780738880 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02005347 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02703419 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083048912 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922246420 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01387186 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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