Provider Demographics
NPI:1295790939
Name:WESTERN NEW YORK ORTHOTIC SUPPLY, INC.
Entity type:Organization
Organization Name:WESTERN NEW YORK ORTHOTIC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:
Authorized Official - Credentials:BOC
Authorized Official - Phone:716-881-0499
Mailing Address - Street 1:1275 DELAWARE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2412
Mailing Address - Country:US
Mailing Address - Phone:716-881-0499
Mailing Address - Fax:716-884-1128
Practice Address - Street 1:1275 DELAWARE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2412
Practice Address - Country:US
Practice Address - Phone:716-881-0499
Practice Address - Fax:716-884-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8211684OtherINDEPENDENT HEALTH ID
NY00030137201OtherBLUE CROSS BLUE SHIELD
NY00030137201OtherUNIVERA COMMUNITY HEALTH
NY080885OtherNORTHWOOD PROVIDER ID
NY00030137201OtherUNIVERA HEALTHCARE ID
NY02066315Medicaid
NY040401000197OtherFIDELIS PROVIDER ID
NYN7AMedicaid
NY1308680001Medicare NSC