Healthcare Provider Details

I. General information

NPI: 1881101954
Provider Name (Legal Business Name): WESTERN NEW YORK INTEGRATED CARE COLLABORATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 DELAWARE AVENUE
BUFFALO NY
14209
US

IV. Provider business mailing address

742 DELAWARE AVENUE
BUFFALO NY
14209
US

V. Phone/Fax

Practice location:
  • Phone: 716-887-2749
  • Fax:
Mailing address:
  • Phone: 716-887-2749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANN BATTAGLIA
Title or Position: BOARD PRESIDENT
Credential:
Phone: 716-532-1020