Healthcare Provider Details

I. General information

NPI: 1033255278
Provider Name (Legal Business Name): INDEPENDENT HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 FARBER LAKES DR
BUFFALO NY
14221-5779
US

IV. Provider business mailing address

511 FARBER LAKES DR
BUFFALO NY
14221-5779
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-3001
  • Fax:
Mailing address:
  • Phone: 716-631-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number01208997
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL CROPP
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 716-631-3001