Basic Information
| Provider Information | |||||||||
| NPI: | 1831152701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINKEL | ||||||||
| FirstName: | PETER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 NIAGARA FALLS BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | NORTH TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141202019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166923302 | ||||||||
| FaxNumber: | 7166924342 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 LIMESTONE DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166329399 | ||||||||
| FaxNumber: | 7166327742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 144507 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000525431011 | 01 | BLUE SHIELD OF WESTERN NY | OTHER | 000525431012 | 01 | BLUE SHIELD OF WESTERN NY | OTHER | 1525351W | 01 | NY | WORKERS COMPENSATION | OTHER | 050701000002 | 01 | FIDELIS | OTHER | 1605752 | 01 | INDEPENDENT HEALTH | OTHER | 00903993 | 05 | NY | MEDICAID |