Provider Demographics
NPI:1952433757
Name:WESTERN NEW YORK BLOODCARE, INC.
Entity Type:Organization
Organization Name:WESTERN NEW YORK BLOODCARE, INC.
Other - Org Name:HEMOPHILIA CENTER OF WESTERN NEW YORK, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:A
Authorized Official - Last Name:REGER
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:716-896-2470
Mailing Address - Street 1:1010 MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1102
Mailing Address - Country:US
Mailing Address - Phone:716-896-2470
Mailing Address - Fax:716-218-4010
Practice Address - Street 1:1010 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1102
Practice Address - Country:US
Practice Address - Phone:716-896-2470
Practice Address - Fax:716-218-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401203R261Q00000X
NY0317963336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011181601OtherUNIVERA
NY00474864Medicaid
NY000000502000OtherBLUE CROSSBLUE SHIELD
NY00011181601OtherUNIVERA