Provider Demographics
NPI:1881279297
Name:WESTERN NEW YORK MEDICAL PRACTICE P.C.
Entity type:Organization
Organization Name:WESTERN NEW YORK MEDICAL PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-0293
Mailing Address - Street 1:70 ELIZABETH BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-3445
Mailing Address - Country:US
Mailing Address - Phone:315-789-3937
Mailing Address - Fax:315-789-2616
Practice Address - Street 1:70 ELIZABETH BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-3445
Practice Address - Country:US
Practice Address - Phone:315-789-3937
Practice Address - Fax:315-789-2616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN NEW YORK MEDICAL PRACTICE P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty