Healthcare Provider Details

I. General information

NPI: 1164136784
Provider Name (Legal Business Name): ELIZABETH DUSSING QUINLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 BARTON ST
BUFFALO NY
14213-1573
US

IV. Provider business mailing address

184 BARTON ST
BUFFALO NY
14213-1573
US

V. Phone/Fax

Practice location:
  • Phone: 716-348-3000
  • Fax: 716-881-6247
Mailing address:
  • Phone: 716-348-3000
  • Fax: 716-881-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: