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General NPI Number Information
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NPI Number | 1881279297
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Entity Type | Organization
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Legal Business Name | WESTERN NEW YORK MEDICAL PRACTICE P.C.
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 70 ELIZABETH BLACKWELL ST
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City | GENEVA
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State | NY
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Zip | 14456-3445
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Country | US
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Telephone | 315-789-3937
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Fax | 315-789-2616
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Provider Business Mailing Address
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Address Line | 70 ELIZABETH BLACKWELL ST
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City | GENEVA
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State | NY
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Zip | 14456-3445
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Country | US
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Telephone | 315-789-3937
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Fax | 315-789-2616
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Authorized Official
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Title or Position | DIRECTOR OF PAYER ENROLLMENT
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Name | NICHOLE S HOLDER
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Credential |
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Telephone | 585-922-0293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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