Healthcare Provider Details

I. General information

NPI: 1306807565
Provider Name (Legal Business Name): CLARK C. STEIN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 3RD ST SUITE 515
NIAGARA FALLS NY
14303-1145
US

IV. Provider business mailing address

525 WASHINGTON ST MANAGED CARE DEPARTMENT
BUFFALO NY
14203-1711
US

V. Phone/Fax

Practice location:
  • Phone: 716-282-2351
  • Fax: 716-282-0146
Mailing address:
  • Phone: 716-856-4494
  • Fax: 716-842-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: