Healthcare Provider Details

I. General information

NPI: 1255604583
Provider Name (Legal Business Name): DELAWARE PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 DELAWARE AVE
BUFFALO NY
14216-1721
US

IV. Provider business mailing address

2550 DELAWARE AVE
BUFFALO NY
14216-1721
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-0230
  • Fax:
Mailing address:
  • Phone: 716-884-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number101753
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS EDGE SCHENK
Title or Position: PARTNER
Credential: MD
Phone: 716-884-0230