Healthcare Provider Details

I. General information

NPI: 1326899790
Provider Name (Legal Business Name): TYLER JOSEPH GRYS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 ELM ST
BUFFALO NY
14203-1621
US

IV. Provider business mailing address

291 ELM ST
BUFFALO NY
14203-1621
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-1800
  • Fax:
Mailing address:
  • Phone: 716-831-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: