Provider Demographics
NPI:1518574060
Name:WESTERN NEW YORK INTEGRATED CARE COLLABORATIVE, INC.
Entity Type:Organization
Organization Name:WESTERN NEW YORK INTEGRATED CARE COLLABORATIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KMICINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:716-431-5100
Mailing Address - Street 1:742 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2202
Mailing Address - Country:US
Mailing Address - Phone:716-431-5100
Mailing Address - Fax:
Practice Address - Street 1:742 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2202
Practice Address - Country:US
Practice Address - Phone:716-431-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty