Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2009-09-30
- Last updated
- 2009-09-30
Specialties
Licenses
- License DE
- 161216796
Location
- Practice location
- 5853 FOREST CREEK DR
- City
- EAST AMHERST NY
- Postal code
- 140511962
- Phone
- 716-541-9101
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.