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Organization
EASTERN NIAGARA HOSPITAL, INC
Active
Organization
EASTERN NIAGARA HOSPITAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL FRANCIS ICKOWSKI MBA, CPA (CHIEF FINANCIAL OFFICER)
(716) 514-5501
Entity
Organization
Contact information
Practice address
521 EAST AVE, LOCKPORT, NY 14094-3201
(716) 514-5501
(716) 514-5549
Mailing address
521 EAST AVE, LOCKPORT, NY 14094-3201
(716) 514-5501
(716) 514-5549
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
—
—
282N00000X
General Acute Care Hospital
Primary
3101000H
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000030000
BCBS BILLING #
NY
01
—
000000031000
BCBS BILLING #
NY
01
—
00011412701
UNIVERA BILLING #
NY
05
—
00354389
—
NY
01
—
13
IHA BILLING #
NY
01
—
89
IHA BILLING #
NY
Enumeration date
10/10/2005
Last updated
07/12/2016
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