Individual
NGA T LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
25 HOPKINS RD, WILLIAMSVILLE, NY 14221-4641
(716) 632-8050
(716) 632-2297
Mailing address
25 HOPKINS RD, WILLIAMSVILLE, NY 14221-4641
(716) 632-8050
(716) 632-2297
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
179810-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01563708
—
NY
Enumeration date
11/02/2005
Last updated
01/28/2013
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