Basic Information
| Provider Information | |||||||||
| NPI: | 1801074539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN NEW YORK IIMMEDIATE MEDICAL CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5101 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142405101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166923302 | ||||||||
| FaxNumber: | 7163629518 | ||||||||
| Practice Location | |||||||||
| Address1: | 2099 NIAGARA FALLS BLVD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142283518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165642273 | ||||||||
| FaxNumber: | 7165642272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2008 | ||||||||
| LastUpdateDate: | 02/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | DANIEL | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7165642273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 159276 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.