Provider Demographics
NPI:1568868388
Name:WESTERN NEW YORK MEDICAL PRACTICE, PC
Entity Type:Organization
Organization Name:WESTERN NEW YORK MEDICAL PRACTICE, PC
Other - Org Name:RED CREEK ORTHOPAEDIC
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP - 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 1:125 RED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4272
Mailing Address - Country:US
Mailing Address - Phone:585-321-0110
Mailing Address - Fax:585-334-6373
Practice Address - Street 1:125 RED CREEK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4272
Practice Address - Country:US
Practice Address - Phone:585-321-0110
Practice Address - Fax:585-334-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100058113Medicare PIN
NYJ100058113Medicare PIN