Healthcare Provider Details

I. General information

NPI: 1790449726
Provider Name (Legal Business Name): NYS DOCCS WENDE CORRECTIONEL FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 WENDE RD
ALDEN NY
14004-1187
US

IV. Provider business mailing address

3622 WENDE RD PO BOX 1187
ALDEN NY
14004-1187
US

V. Phone/Fax

Practice location:
  • Phone: 716-937-4000
  • Fax:
Mailing address:
  • Phone: 716-937-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STEWART THOMAS ECKERT
Title or Position: SUPERVISING SUPERINTENDENT
Credential: HEAD ADMINISTRATOR
Phone: 716-937-4000