Healthcare Provider Details

I. General information

NPI: 1306951207
Provider Name (Legal Business Name): HENRY BROCK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVE
BUFFALO NY
14215-1129
US

IV. Provider business mailing address

43 MOORGATE CT
EAST AMHERST NY
14051-1221
US

V. Phone/Fax

Practice location:
  • Phone: 716-834-9200
  • Fax:
Mailing address:
  • Phone: 716-688-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number002421-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: