Provider Demographics
NPI:1750742367
Name:FALLON HEALTH WEINBERG
Entity type:Organization
Organization Name:FALLON HEALTH WEINBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FASOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-810-1828
Mailing Address - Street 1:461 JOHN JAMES AUDUBON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228
Mailing Address - Country:US
Mailing Address - Phone:716-810-1895
Mailing Address - Fax:716-250-3160
Practice Address - Street 1:461 JOHN JAMES AUDUBON PKWY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1141
Practice Address - Country:US
Practice Address - Phone:716-810-1895
Practice Address - Fax:716-250-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization