Healthcare Provider Details

I. General information

NPI: 1134771009
Provider Name (Legal Business Name): DENT NEUROLOGIC GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GEORGE KARL BLVD
BUFFALO NY
14221-7183
US

IV. Provider business mailing address

DENT NEUROLOGIC GROUP, LLP 3980 SHERIDAN DRIVE
AMHERST NY
14226
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-2000
  • Fax: 716-250-2040
Mailing address:
  • Phone: 716-250-2000
  • Fax: 716-250-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA PALMIERO
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 716-250-6035