Healthcare Provider Details

I. General information

NPI: 1376733576
Provider Name (Legal Business Name): CLAUDIA ANNE MONROE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W MAIN ST
BROCTON NY
14716-9750
US

IV. Provider business mailing address

PO BOX 643
BROCTON NY
14716-0643
US

V. Phone/Fax

Practice location:
  • Phone: 716-792-5000
  • Fax: 716-792-5001
Mailing address:
  • Phone: 716-792-5000
  • Fax: 716-792-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number010920-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: