Individual
ERL PRESENTACION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
70 JEWETT PKWY, BUFFALO, NY 14214-2391
(716) 533-4230
Mailing address
70 JEWETT PKWY, BUFFALO, NY 14214-2391
(716) 533-4230
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/26/2018
Last updated
10/26/2018
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