=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336621275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAN2PEAK INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2018
-----------------------------------------------------
Last Update Date | 09/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4545 TRANSIT RD STE 355
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-6012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-906-2102
-----------------------------------------------------
Fax | 844-795-7476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 N UNION RD
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-5364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-982-8061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | PETER CUMMINGS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-906-2102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------