Healthcare Provider Details

I. General information

NPI: 1467697474
Provider Name (Legal Business Name): GRAND ISLAND PRIMARY MEDICAL CARE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-2171
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD SUITE 208
NORTH TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-773-8925
  • Fax: 716-773-8928
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-362-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE PLUMB
Title or Position: OWNER
Credential: MD
Phone: 716-773-8925