Organization
FOUR SEASONS MEDICAL OF WNY PC
Active
Parent organization
FOUR SEASONS MEDICAL OF WNY PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOUR SEASONS MEDICAL OF WNY PC
Authorized official
MRS. MARY ANN DIRIENZO LPN (CREDENTIALING SPECIALIST)
(716) 984-2090
Entity
Organization
Contact information
Practice address
2625 HARLEM RD, STE 70, CHEEKTOWAGA, NY 14225-4031
(716) 462-5552
(716) 424-0790
Mailing address
2625 HARLEM RD, STE 70, CHEEKTOWAGA, NY 14225-4031
(716) 462-5552
(716) 424-0790
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
195126
NY
Other
Enumeration date
12/14/2016
Last updated
12/14/2016
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