Healthcare Provider Details

I. General information

NPI: 1497860027
Provider Name (Legal Business Name): EDWARD F KOCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HIGH ST
BUFFALO NY
14203-1149
US

IV. Provider business mailing address

6255 SHERIDAN DR SUITE 304
WILLIAMSVILLE NY
14221-4836
US

V. Phone/Fax

Practice location:
  • Phone: 716-857-8745
  • Fax: 716-823-5020
Mailing address:
  • Phone: 716-857-8666
  • Fax: 716-857-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000835-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: