Healthcare Provider Details

I. General information

NPI: 1194876300
Provider Name (Legal Business Name): MAIN BUFFALO PEDIATRICS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 MAIN ST
BUFFALO NY
14214-1706
US

IV. Provider business mailing address

2924 MAIN ST
BUFFALO NY
14214-1706
US

V. Phone/Fax

Practice location:
  • Phone: 716-837-0995
  • Fax: 716-837-1203
Mailing address:
  • Phone: 716-837-0995
  • Fax: 716-837-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number169949-1
License Number StateNY

VIII. Authorized Official

Name: DR. EMILY S FRIEDAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 716-837-0995