Provider Demographics
NPI:1306356340
Name:NEIGHBORHOOD HEALTH CENTER OF WNY, INC.
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTH CENTER OF WNY, INC.
Other - Org Name:PHARMACY AT BLASDELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAEFNERFNP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-875-2904
Mailing Address - Street 1:4233 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-1216
Mailing Address - Country:US
Mailing Address - Phone:716-332-3380
Mailing Address - Fax:716-332-3085
Practice Address - Street 1:4233 LAKE AVE
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-1216
Practice Address - Country:US
Practice Address - Phone:716-332-3380
Practice Address - Fax:716-332-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0356423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy