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Organization
EASTERN NIAGARA MEDICAL GROUP
Active
Organization
EASTERN NIAGARA MEDICAL GROUP
Active
Parent organization
EASTERN NIAGARA HOSPITAL, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTERN NIAGARA HOSPITAL, INC
Authorized official
MR. MICHAEL FRANCIS ICKOWSKI SR. MBA, CPA (CFO)
(716) 514-5501
Entity
Organization
Contact information
Practice address
53 ELIZABETH DR, LOCKPORT, NY 14094-5226
(716) 514-5501
(716) 514-5549
Mailing address
521 EAST AVE, LOCKPORT, NY 14094-3201
(716) 514-5501
(716) 514-5549
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3101000H
NY
207R00000X
Internal Medicine Physician
3101000H
NY
207RG0100X
Gastroenterology Physician
3101000H
NY
Other
Enumeration date
08/30/2016
Last updated
09/01/2016
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