Healthcare Provider Details

I. General information

NPI: 1396170981
Provider Name (Legal Business Name): CLINICAL NEUROSCIENCE SERVICES MED/SURG PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4050 HARLEM RD
AMHERST NY
14226-4711
US

IV. Provider business mailing address

4050 HARLEM RD
AMHERST NY
14226-4711
US

V. Phone/Fax

Practice location:
  • Phone: 716-803-1507
  • Fax: 716-803-1508
Mailing address:
  • Phone: 716-803-1507
  • Fax: 716-803-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE RAND GUTERMAN
Title or Position: OWNER
Credential: M.D.
Phone: 716-803-1507