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General NPI Number Information
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NPI Number | 1073068524
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Entity Type | Organization
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Legal Business Name | WNY DESIGNATED DRIVERS
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 472 TEAKWOOD TER
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3906
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Country | US
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Telephone | 716-800-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 472 TEAKWOOD TER
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3906
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Country | US
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Telephone | 716-800-2294
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID PATRICK LIPINOGA
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Credential | MBA
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Telephone | 716-800-2294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | FMM 7419
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License Number State | NY
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