Provider Demographics
NPI:1083151518
Name:WESTERN NEW YORK MEDICAL PRACTICE P.C
Entity Type:Organization
Organization Name:WESTERN NEW YORK MEDICAL PRACTICE P.C
Other - Org Name:WNY, FINGER LAKES BONE & JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-0089
Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2126
Mailing Address - Country:US
Mailing Address - Phone:585-412-6491
Mailing Address - Fax:
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2126
Practice Address - Country:US
Practice Address - Phone:585-412-6491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty