Provider Demographics
NPI:1972872919
Name:WNY MEDICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:WNY MEDICAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA
Authorized Official - Phone:716-931-4963
Mailing Address - Street 1:700 MICHIGAN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1536
Mailing Address - Country:US
Mailing Address - Phone:716-931-4963
Mailing Address - Fax:716-923-2791
Practice Address - Street 1:700 MICHIGAN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1536
Practice Address - Country:US
Practice Address - Phone:716-931-4963
Practice Address - Fax:716-923-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical