Healthcare Provider Details

I. General information

NPI: 1962794271
Provider Name (Legal Business Name): MRS. ELENA NOSWORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DELAWARE AVE SUITE 400
BUFFALO NY
14202-3803
US

IV. Provider business mailing address

3020 BAILEY AVE
BUFFALO NY
14215-2814
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: