Basic Information
| Provider Information | |||||||||
| NPI: | 1669546073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASPIRE OF WESTERN NEW YORK INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2356 N FOREST RD | ||||||||
| Address2: | |||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140681224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165055560 | ||||||||
| FaxNumber: | 7168940148 | ||||||||
| Practice Location | |||||||||
| Address1: | 2356 N FOREST RD | ||||||||
| Address2: | |||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140681224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165055720 | ||||||||
| FaxNumber: | 7166322965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HANDSCHUMAKER | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7165055564 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 01046377 | 05 | NY | MEDICAID |