Provider Demographics
NPI:1306214689
Name:WESTERN NEW YORK MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:WESTERN NEW YORK MEDICAL PRACTICE PC
Other - Org Name:WNY WYOMING OB/GYN
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VICE PRESIDENT-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-1223
Mailing Address - Street 1:121 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1567
Mailing Address - Country:US
Mailing Address - Phone:585-786-8350
Mailing Address - Fax:585-786-8362
Practice Address - Street 1:121 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1567
Practice Address - Country:US
Practice Address - Phone:585-786-8350
Practice Address - Fax:585-786-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty