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General NPI Number Information
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NPI Number | 1740600147
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Entity Type | Organization
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Legal Business Name | FIDELIS CARE
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 480 CROSSPOINT PKWY
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City | GETZVILLE
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State | NY
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Zip | 14068-1608
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Country | US
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Telephone | 888-343-3547
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Fax | 877-533-2405
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Provider Business Mailing Address
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Address Line | 480 CROSSPOINT PKWY
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City | GETZVILLE
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State | NY
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Zip | 14068-1608
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Country | US
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Telephone | 888-343-3547
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Fax | 877-533-2405
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. MICHAEL CARDAMONE
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Credential | PHARM D
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Telephone | 888-343-3547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 20 055939
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License Number State | NY
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