| NPI | 1346796398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL FRANCIS ICKOWSKI CFO 716-514-5501 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 3101000H) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 3101000H) |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 3101000H) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-09-01 |