Individual
EDWARD REVERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1021 BROADWAY ST, BUFFALO, NY 14212-1460
(716) 662-2040
(716) 662-0019
Mailing address
227 THORN AVE, ORCHARD PARK, NY 14127-2600
(716) 662-2040
(716) 662-0019
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
CRPA-5254
NY
175T00000X
Peer Specialist
Primary
NYCPS-P4548
NY
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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