Provider Demographics
NPI:1801177415
Name:WESTERN NEW YORK MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:WESTERN NEW YORK MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED FITTER
Authorized Official - Phone:585-243-3080
Mailing Address - Street 1:87 YARMOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610
Mailing Address - Country:US
Mailing Address - Phone:585-727-6176
Mailing Address - Fax:
Practice Address - Street 1:3 CENTER ST
Practice Address - Street 2:BOX 536
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1275
Practice Address - Country:US
Practice Address - Phone:585-727-6176
Practice Address - Fax:585-243-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX IDENTIFICATION NUMBER