1811293996 NPI number — 90 CAFFERTY ROAD OPERATING COMPANY, LP

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 1811293996 NPI number — 90 CAFFERTY ROAD OPERATING COMPANY, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
90 CAFFERTY ROAD OPERATING COMPANY, LP
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:
1811293996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 SENECA ST STE 100
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:
14204-1963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-361-6636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 CAFFERTY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POINT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18950-0217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-297-5555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KENWORTHY
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIRECTOR REVENUE CYCLE MGMT
Authorized Official Telephone Number:
716-361-6636

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  135770 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 136680 . This is a "PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 135770 . This is a "PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 135830 . This is a "PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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