Facts
- Status
- A
- Credential
- PA
- Type
- Individual
- Enumeration date
- 2008-08-07
- Last updated
- 2013-07-16
Specialties
Licenses
- License NY
- 012649-1
Location
- Practice location
- 8750 TRANSIT RD, SUITE 105
- City
- EAST AMHERST NY
- Postal code
- 140512610
- Phone
- 716-636-1470
Medicare
- PECOS
- A PECOS enrollment row matches 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.