Healthcare Provider Details

I. General information

NPI: 1437339447
Provider Name (Legal Business Name): MARY LOUISE LENAHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9388 TRANSIT RD
EAST AMHERST NY
14051-1494
US

IV. Provider business mailing address

9388 TRANSIT RD
EAST AMHERST NY
14051-1494
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-4377
  • Fax: 716-689-4843
Mailing address:
  • Phone: 716-689-4377
  • Fax: 716-689-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number153446-1
License Number StateNY

VIII. Authorized Official

Name: DR. MARY LOUISE LENAHAN
Title or Position: OWNER
Credential: MD
Phone: 716-689-4377