Provider Demographics
NPI:1669833158
Name:CCN -WNY IPA LLC
Entity Type:Organization
Organization Name:CCN -WNY IPA LLC
Other - Org Name:NEW YORK HEALTH CARE PROVIDERS IPA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-251-0300
Mailing Address - Street 1:4 GREENWICH OFFICE PARK
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5153
Mailing Address - Country:US
Mailing Address - Phone:914-251-0300
Mailing Address - Fax:
Practice Address - Street 1:4 GREENWICH OFFICE PARK
Practice Address - Street 2:FLOOR 2
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5153
Practice Address - Country:US
Practice Address - Phone:914-251-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVICORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization