Healthcare Provider Details

I. General information

NPI: 1407281835
Provider Name (Legal Business Name): 200 BASSETT ROAD OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BASSETT RD
WILLIAMSVILLE NY
14221-2639
US

IV. Provider business mailing address

641 LEXINGTON AVE 31ST FLOOR
NEW YORK NY
10022-4503
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-6681
  • Fax:
Mailing address:
  • Phone: 212-802-7609
  • Fax: 646-924-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number031932
License Number StateNY

VIII. Authorized Official

Name: MR. GREGORY HOOK
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 212-802-7609