1548334683 NPI number — NYSARC NIAGARA COUNTY CHAPTER

Table of content: (NPI 1548334683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548334683 NPI number — NYSARC NIAGARA COUNTY CHAPTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYSARC NIAGARA COUNTY CHAPTER
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:
1548334683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 FACTORY OUTLET BLVD
Provider Second Line Business Mailing Address:
PO BOX 360
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14304-1798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-297-6400
Provider Business Mailing Address Fax Number:
716-504-2624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MEAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14120-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-297-6400
Provider Business Practice Location Address Fax Number:
716-504-2624
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NARKIEWICZ
Authorized Official First Name:
A
Authorized Official Middle Name:
LYNELL
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
716-504-2625

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6116462 . This is a "OPERATING CERTIFICATE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02175708 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com