Provider Demographics
NPI:1235579319
Name:FINGER LAKES WIC PROGRAM
Entity Type:Organization
Organization Name:FINGER LAKES WIC PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF WIC / VMA
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-394-9240
Mailing Address - Street 1:79 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1906
Mailing Address - Country:US
Mailing Address - Phone:585-394-9240
Mailing Address - Fax:585-394-9285
Practice Address - Street 1:79 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1906
Practice Address - Country:US
Practice Address - Phone:585-394-9240
Practice Address - Fax:585-394-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health