Healthcare Provider Details

I. General information

NPI: 1396823399
Provider Name (Legal Business Name): HAND & UPPER EXTREMITY SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GATES CIR
BUFFALO NY
14209-1120
US

IV. Provider business mailing address

3 GATES CIR
BUFFALO NY
14209-1120
US

V. Phone/Fax

Practice location:
  • Phone: 716-887-4040
  • Fax:
Mailing address:
  • Phone: 716-887-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE JETTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 716-887-4479