Healthcare Provider Details

I. General information

NPI: 1639209067
Provider Name (Legal Business Name): WESTERN NEW YORK UROLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 FOOTE AVE
JAMESTOWN NY
14701-6947
US

IV. Provider business mailing address

PO BOX 1094 WHOLESALE LOCKBOX CD2
BUFFALO NY
14240-1094
US

V. Phone/Fax

Practice location:
  • Phone: 716-338-9200
  • Fax: 716-338-9250
Mailing address:
  • Phone: 716-488-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER J WALTER
Title or Position: PHYSICIAN PARTNER
Credential: MD
Phone: 716-488-1851