Healthcare Provider Details

I. General information

NPI: 1982644977
Provider Name (Legal Business Name): THOMAS FREDERICK RILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2648
US

IV. Provider business mailing address

63 CRESCENT AVE
BUFFALO NY
14214-2627
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-1271
  • Fax:
Mailing address:
  • Phone: 716-831-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number199567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: