Healthcare Provider Details

I. General information

NPI: 1740600147
Provider Name (Legal Business Name): FIDELIS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CROSSPOINT PKWY
GETZVILLE NY
14068-1608
US

IV. Provider business mailing address

480 CROSSPOINT PKWY
GETZVILLE NY
14068-1608
US

V. Phone/Fax

Practice location:
  • Phone: 888-343-3547
  • Fax: 877-533-2405
Mailing address:
  • Phone: 888-343-3547
  • Fax: 877-533-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number20 055939
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL CARDAMONE
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 888-343-3547