Healthcare Provider Details

I. General information

NPI: 1376970632
Provider Name (Legal Business Name): ROBERT C DUNDON JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12705 UEBELHOER RD
ALDEN NY
14004
US

IV. Provider business mailing address

3925 SHERIDAN DR STE 100
AMHERST NY
14226-1738
US

V. Phone/Fax

Practice location:
  • Phone: 716-983-6079
  • Fax:
Mailing address:
  • Phone: 716-250-6492
  • Fax: 716-250-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338322
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: