Healthcare Provider Details

I. General information

NPI: 1801177415
Provider Name (Legal Business Name): WESTERN NEW YORK MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CENTER ST BOX 536
GENESEO NY
14454-1275
US

IV. Provider business mailing address

87 YARMOUTH STREET
ROCHESTER NY
14610
US

V. Phone/Fax

Practice location:
  • Phone: 585-727-6176
  • Fax: 585-243-4406
Mailing address:
  • Phone: 585-727-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN SCOTT SLACK
Title or Position: OWNER/OPERATOR
Credential: CERTIFIED FITTER
Phone: 585-243-3080