Healthcare Provider Details

I. General information

NPI: 1275048738
Provider Name (Legal Business Name): ST JOHN NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 TRANSIT RD STE 3
EAST AMHERST NY
14051-1786
US

IV. Provider business mailing address

8770 TRANSIT RD STE 3
EAST AMHERST NY
14051-1786
US

V. Phone/Fax

Practice location:
  • Phone: 716-245-4431
  • Fax: 716-245-4432
Mailing address:
  • Phone: 716-245-4431
  • Fax: 716-245-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIANNE E ST JOHN
Title or Position: OWNER
Credential: NP
Phone: 716-491-3221