1760434906 NPI number — MONROE WHEELCHAIR 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 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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