Provider Demographics
NPI:1710287891
Name:ORCHARD PARK EARLY INTERVENTION RN SERVICES, PLLC
Entity Type:Organization
Organization Name:ORCHARD PARK EARLY INTERVENTION RN SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WETTLAUFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:716-667-2294
Mailing Address - Street 1:40 CENTRE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4100
Mailing Address - Country:US
Mailing Address - Phone:716-667-2294
Mailing Address - Fax:716-667-2272
Practice Address - Street 1:40 CENTRE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4100
Practice Address - Country:US
Practice Address - Phone:716-667-2294
Practice Address - Fax:716-667-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency