Individual
ALICIA R BOMMERSBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
295 ESSJAY RD, WILLIAMSVILLE, NY 14221-8216
(716) 630-1022
(716) 250-5958
Mailing address
6255 SHERIDAN DR, SUITE 304, WILLIAMSVILLE, NY 14221-4836
(716) 857-8666
(716) 857-8944
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
011319
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00027739701
UNIVERA
NY
01
—
000528705001
HEALTH NOW
NY
05
—
02808822
—
NY
01
—
9513979
INDEPENDENT HEALTH
NY
Enumeration date
07/29/2006
Last updated
04/04/2023
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