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General NPI Number Information
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NPI Number | 1235579319
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Entity Type | Organization
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Legal Business Name | FINGER LAKES WIC PROGRAM
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 79 S MAIN ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1906
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Country | US
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Telephone | 585-394-9240
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Fax | 585-394-9285
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Provider Business Mailing Address
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Address Line | 79 S MAIN ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1906
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Country | US
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Telephone | 585-394-9240
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Fax | 585-394-9285
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Authorized Official
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Title or Position | VP OF WIC / VMA
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Name | CYNTHIIA WALTON
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Credential |
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Telephone | 585-394-9240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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