Provider Demographics
NPI:1508408998
Name:TRINITY MEDICAL WNY PC
Entity Type:Organization
Organization Name:TRINITY MEDICAL WNY PC
Other - Org Name:TRINITY NIAGARA FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-298-5862
Mailing Address - Street 1:144 GENESEE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1560
Mailing Address - Country:US
Mailing Address - Phone:716-601-3690
Mailing Address - Fax:
Practice Address - Street 1:7300 PORTER RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-5716
Practice Address - Country:US
Practice Address - Phone:716-298-5862
Practice Address - Fax:716-298-5896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY MEDICAL WNY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-17
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty