1598830218 NPI number — WESTERN NEW YORK DC, LLC

Table of content: (NPI 1598830218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598830218 NPI number — WESTERN NEW YORK DC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN NEW YORK DC, LLC
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:
1598830218
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:
2100 CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-2838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-785-7523
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 TAYLOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-209-7200
Provider Business Practice Location Address Fax Number:
716-209-7206
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
303-785-7521

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  1401229R , 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: 01984981 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000378002 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2V . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com