Healthcare Provider Details

I. General information

NPI: 1811992019
Provider Name (Legal Business Name): MICHAEL JOHN ENDL II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 NIAGARA FALLS BLVD STE 130
AMHERST NY
14228-2046
US

IV. Provider business mailing address

6500 PORTER RD STE 2020
NIAGARA FALLS NY
14304-1529
US

V. Phone/Fax

Practice location:
  • Phone: 716-564-2020
  • Fax: 716-564-2060
Mailing address:
  • Phone: 716-282-1114
  • Fax: 716-282-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number221211-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number221211-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: