1760434906 NPI number — MONROE WHEELCHAIR INC

Table of content: (NPI 1760434906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760434906 NPI number — MONROE WHEELCHAIR INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE WHEELCHAIR 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:
1760434906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2165 BRIGHTON HENRIETTA TOWN LINE RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14623-2755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-385-3920
Provider Business Mailing Address Fax Number:
585-385-6966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
388 OLD NISKAYUNA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-783-1653
Provider Business Practice Location Address Fax Number:
518-783-6305
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WESTERDAHL
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
585-385-3920

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00011191701 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9660309 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000551000003 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000551000003 . This is a "BC/BS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 25177 . This is a "DMENSION BENEFIT MGMT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 888335 . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10049384-8085 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: MB . This is a "BLUE CROSS FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040401000140 . This is a "FIDELIS CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02414744 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7183753 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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