1447669742 NPI number — CAZENOVIA RECOVERY SYSTEMS, 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 1447669742 NPI number — CAZENOVIA RECOVERY SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAZENOVIA RECOVERY SYSTEMS, 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:
1447669742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2495 MAIN ST STE 417
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:
14214-2152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-852-4331
Provider Business Mailing Address Fax Number:
716-852-4533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ALBANY 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:
14213-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-882-2108
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERNDON
Authorized Official First Name:
LINDSAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
716-314-5903

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03A3070 . This is a "NYS DOH NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 220912282 . This is a "NY OASAS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 07117926 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".