Individual
LYNNE MARIE FRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
219 BRYANT STREET, BUFFALO, NY 14222-2006
(716) 250-6545
(716) 250-6566
Mailing address
4511 HARLEM ROAD, SUITE 202, AMHERST, NY 14226-3822
(716) 839-6720
(716) 839-6740
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
006966
NY
363AM0700X
Medical Physician Assistant
Primary
006966-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026514404
UNIVERA
—
01
—
000560443006
BLUE CROSS/COMMUNITY BLUE
NY
01
—
000560443011
BC/BS
—
05
—
02759662
—
NY
01
—
070924000060
FIDELIS
—
01
—
9512047
IHA
—
Enumeration date
10/12/2005
Last updated
10/22/2008
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