Individual
ERIN E DIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
120 GARDENVILLE PARKWAY WEST, WEST SENECA HEALTH CENTER, WEST SENECA, NY 14224
(716) 668-3600
(716) 656-4223
Mailing address
120 GARDENVILLE PKWY W, ATTN: BETTY PICCILLO, WEST SENECA, NY 14224-1324
(716) 857-6150
(716) 656-4074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006550
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000570455002
BCBS OF WNY
NY
01
—
040511000518
FIDELIS CARE
NY
01
—
11563367
CAQH
NY
01
—
177012DL
PREFERRED CARE
NY
01
—
9513164
IHA
NY
Enumeration date
04/28/2006
Last updated
11/17/2009
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