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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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