Healthcare Provider Details

I. General information

NPI: 1518948462
Provider Name (Legal Business Name): BUFFALO OTOLARYNGOLOGY GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 DELAWARE AVE THIRD FLOOR
BUFFALO NY
14209-2007
US

IV. Provider business mailing address

897 DELAWARE AVE THIRD FLOOR
BUFFALO NY
14209-2007
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-6800
  • Fax: 716-883-6853
Mailing address:
  • Phone: 716-883-6800
  • Fax: 716-883-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MS. TINEKE M HALL
Title or Position: OFFICE MANAGER
Credential:
Phone: 716-883-6800