Provider Demographics
NPI:1780976613
Name:ADVANCED ALLERGY AND ASTHMA CARE OF WESTERN NEW YORK P.C.
Entity type:Organization
Organization Name:ADVANCED ALLERGY AND ASTHMA CARE OF WESTERN NEW YORK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CUMELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-633-5277
Mailing Address - Street 1:333 INTERNATIONAL DR
Mailing Address - Street 2:SUITE B1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5726
Mailing Address - Country:US
Mailing Address - Phone:716-633-5277
Mailing Address - Fax:716-633-5270
Practice Address - Street 1:333 INTERNATIONAL DR
Practice Address - Street 2:SUITE B1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5726
Practice Address - Country:US
Practice Address - Phone:716-633-5277
Practice Address - Fax:716-633-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140792207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00833087Medicaid
B70623Medicare PIN