Basic Information
| Provider Information | |||||||||
| NPI: | 1306909957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLANNED PARENTHOOD OF CENTRAL AND WESTERN NEW YORK, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146052929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855462771 | ||||||||
| FaxNumber: | 5854547001 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146052929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855462771 | ||||||||
| FaxNumber: | 5854547001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 05/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | OLECK | ||||||||
| AuthorizedOfficialFirstName: | CHRISTIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/CFO ACTING CEO | ||||||||
| AuthorizedOfficialTelephone: | 5855462771 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0005X | 420531 | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility | 363LW0102X | 420531 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 261QA0005X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility |
ID Information
| ID | Type | State | Issuer | Description | 00474960 | 05 | NY | MEDICAID |