Provider Demographics
NPI:1538595939
Name:VA OF WNY
Entity type:Organization
Organization Name:VA OF WNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, BEHAVIORAL HEALTH
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-862-3131
Mailing Address - Street 1:1310 DELAWARE AVE
Mailing Address - Street 2:APT 314
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1140
Mailing Address - Country:US
Mailing Address - Phone:716-931-4794
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-834-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273R00000X273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70890OtherPRI ASSESSOR NUMBER