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General NPI Number Information
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NPI Number | 1679236756
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Entity Type | Organization
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Legal Business Name | CINQ-NY HEALTH HOME IPA, LLC
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 564 NIAGARA ST BLDG 2
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City | BUFFALO
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State | NY
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Zip | 14201-1108
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Country | US
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Telephone | 716-247-5282
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Fax |
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Provider Business Mailing Address
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Address Line | 6536 E GREYTHORN DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85266-6761
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Country | US
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Telephone | 602-920-5231
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | WILLIAM A HAGAN
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Credential |
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Telephone | 602-920-5231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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