Individual
JONATHAN RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5959 BIG TREE RD STE 103, ORCHARD PARK, NY 14127-2291
(716) 218-1000
Mailing address
PO BOX 8000 DEPT 883, BUFFALO, NY 14267-0001
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD456949
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04879530
—
NY
Enumeration date
04/11/2009
Last updated
04/22/2019
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