Healthcare Provider Details

I. General information

NPI: 1184685315
Provider Name (Legal Business Name): KENMORE PHYSICIANS ASSOCIATION, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 ELMWOOD AVE
KENMORE NY
14217-1304
US

IV. Provider business mailing address

50 ALCONA AVE
AMHERST NY
14226-2201
US

V. Phone/Fax

Practice location:
  • Phone: 716-447-6100
  • Fax:
Mailing address:
  • Phone: 716-834-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MAHER
Title or Position: C.P.A.
Credential:
Phone: 716-834-1193