Individual
GLENN H FREDENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
40 LA RIVIERE DR STE 201, BUFFALO, NY 14202-4344
(518) 335-5097
Mailing address
9467 STATE ROUTE 9, CHAZY, NY 12921-2043
(518) 335-5097
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
101.0134798
VT
Other
Enumeration date
04/06/2021
Last updated
04/27/2022
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