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General NPI Number Information
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NPI Number | 1134030067
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Entity Type | Organization
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Legal Business Name | CELLACTIVE, LLC
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 779 BROAD ST STE 2
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City | SALAMANCA
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State | NY
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Zip | 14779-1330
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Country | US
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Telephone | 716-271-1312
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Fax | 716-271-1290
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Provider Business Mailing Address
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Address Line | 14411 NY-438
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City | GOWANDA
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State | NY
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Zip | 14070-9797
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Country | US
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Telephone | 716-532-4466
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ROSS L JOHN
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Credential |
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Telephone | 716-532-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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