Organization
EAST AURORA PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA J JORDAN (CERTIFIED MEDICAL OFFICE MANAGER)
(716) 652-0237
Entity
Organization
Contact information
Practice address
94 OLEAN ST, EAST AURORA, NY 14052-2531
(716) 652-0237
(716) 652-0983
Mailing address
94 OLEAN ST, EAST AURORA, NY 14052-2531
(716) 652-0237
(716) 652-0983
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124023650
PNP
NY
01
—
1417952920
PNP
NY
01
—
1437121480
MD
NY
01
—
1528063039
MD
NY
01
—
1568467090
MD
NY
01
—
1982609491
MD
NY
Enumeration date
04/06/2006
Last updated
07/20/2010
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