Healthcare Provider Details

I. General information

NPI: 1912931650
Provider Name (Legal Business Name): ALDEN MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12845 BROADWAY
ALDEN NY
14004-1223
US

IV. Provider business mailing address

12845 BROADWAY
ALDEN NY
14004-1223
US

V. Phone/Fax

Practice location:
  • Phone: 716-937-3255
  • Fax: 716-204-7481
Mailing address:
  • Phone: 716-937-3255
  • Fax: 716-204-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: YELLAMRAJU R KUMAR
Title or Position: PARTNER
Credential: MD
Phone: 716-937-3255