Facts
- Status
- A
- Credential
- PT
- Type
- Individual
- Enumeration date
- 2010-08-26
- Last updated
- 2010-08-26
Specialties
Licenses
- License NY
- 021577-1
Location
- Practice location
- 6298 BRIDLEWOOD DR S
- City
- EAST AMHERST NY
- Postal code
- 140512026
- Phone
- 716-741-9387
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.