Healthcare Provider Details

I. General information

NPI: 1730820796
Provider Name (Legal Business Name): BIANCA MARRARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 ELIZABETH DR
LOCKPORT NY
14094-5226
US

IV. Provider business mailing address

2372 SWEET HOME RD STE 3
AMHERST NY
14228-2330
US

V. Phone/Fax

Practice location:
  • Phone: 716-566-9900
  • Fax:
Mailing address:
  • Phone: 716-834-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number341663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: