Healthcare Provider Details

I. General information

NPI: 1780690990
Provider Name (Legal Business Name): LAWRENCE R BIRZON DC, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 DELAWARE AVE
KENMORE NY
14217-1002
US

IV. Provider business mailing address

3734 DELAWARE AVE
KENMORE NY
14217-1002
US

V. Phone/Fax

Practice location:
  • Phone: 716-874-1500
  • Fax: 716-874-6396
Mailing address:
  • Phone: 716-874-1500
  • Fax: 716-874-6396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX003059-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009221-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: