Organization
KENMORE URGENT CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARIK ELIBOL M.D. (OWNERR)
(716) 876-7606
Entity
Organization
Contact information
Practice address
2949 ELMWOOD AVE, SUITE 104, KENMORE, NY 14217-1356
(716) 876-7606
(716) 876-7608
Mailing address
2949 ELMWOOD AVE, SUITE 104, KENMORE, NY 14217-1356
(716) 876-7606
(716) 876-7608
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
102346
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00647865
—
NY
Enumeration date
09/17/2013
Last updated
09/18/2013
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