JERICHO ROAD MINISTRIES, INC. (NPI# 1205474681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205474681 |
| Entity Type | Organization |
| Organization Name | JERICHO ROAD MINISTRIES, INC. |
| Practice Address |
100 E Tupper St Buffalo NY 14203-1315 |
| Mailing Address |
184 Barton St Buffalo NY 14213-1573 |
| Practice Telephone | 7168816191 |
| Mailing Telephone | 7163483000 |
| Mailing Fax Number | 7168816247 |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2019-12-16 |
| Authorized Official Name | ETHAN GABLE (C.O.O.) |
| Authorized Official Telephone | 7168816191 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | JERICHO ROAD MINISTRIES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Jericho Road Community Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548825482 | Jericho Road Ministries, Inc. | Pharmacy | 1021 Broadway Street, Buffalo, NY 14212-1460 | 2019-05-07 |
| 1619307022 | Jericho Road Ministries, Inc. | Clinic/Center | 1609 Genesee St, Buffalo, NY 14211-1616 | 2013-11-21 |
| 1952893091 | Jericho Road Ministries, Inc. | Clinic/Center | 1021 Broadway St, Buffalo, NY 14212-1460 | 2018-06-05 |
| Street Address |
100 E TUPPER ST |
| City | BUFFALO |
| State | NY |
| Zip Code | 14203-1315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386032928 | Karyanne Cox | Physician Assistant | 100 E Tupper St, Buffalo, NY 14203-1315 | 2015-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912514902 | Valerie Anne Conley | Counselor | 475 Elllicott St., Buffalo, NY 14203 | 2020-09-24 |
| 1457975674 | Qing Ma | Pharmacist | Nys Center of Excellence In Bioinformatics and Life Sci, 701 Ellicott Street, Buffalo, NY 14203 | 2020-06-03 |
| 1265056659 | Elizabeth Nicole Mancuso | Student in an Organized Health Care Education/Training Program | 1001 Main Street University At Buffalo, Department of P, 5th Floor, Buffalo, NY 14203 | 2020-06-02 |
| 1720601404 | Ronak Dhiraj Bahuva | Student in an Organized Health Care Education/Training Program | 955 Main Street, University At Buffalo, Jacobs School O, Buffalo, NY 14203 | 2020-05-28 |
| 1780207266 | Jaya Mishra | Student in an Organized Health Care Education/Training Program | 818 Ellicot Street, Buffalo, NY 14203 | 2020-05-19 |
| 1013530617 | Amanpreet Kaur Singh | Student in an Organized Health Care Education/Training Program | 77 Goodell Street Department of Medicine, Suite 240, Buffalo, NY 14203 | 2020-05-19 |
| 1013538917 | Leen Hosam Alyacoub | Student in an Organized Health Care Education/Training Program | 100 High Street, D2-76 Buffalo, Ny 14203, Buffalo Gener, Buffall, NY 14203 | 2020-05-01 |
| 1003436601 | Maxiam Dean | Student in an Organized Health Care Education/Training Program | Ub Family Residency Program, 77 Goodell Street, 2nd Floor, Buffalo, NY 14203 | 2020-04-23 |
| 1144849837 | Jennifer Anthone-kloss | Student in an Organized Health Care Education/Training Program | Anesthesiology Residency & Fellowship Programs, Ub Gateway, 77 Goodell Street, Suite 550, Buffalo, NY 14203 | 2020-04-13 |
| 1821658873 | Peter William Ip Fung Chun | Student in an Organized Health Care Education/Training Program | 1001 Main Street, Room 5145, Division of Pediatric Medical Education, Buffalo, NY 14203 | 2019-06-20 |
| Find all providers in zip 14203 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619307022 | Jericho Road Ministries, Inc. | Clinic/Center | 1609 Genesee St, Buffalo, NY 14211-1616 | 2013-11-21 |
| 1952893091 | Jericho Road Ministries, Inc. | Clinic/Center | 1021 Broadway St, Buffalo, NY 14212-1460 | 2018-06-05 |
| 1801238134 | Womencare, Inc | Clinic/Center | Rr 2 Box 93, Buffalo, WV 25033-9427 | 2013-07-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.