Healthcare Provider Details

I. General information

NPI: 1336113810
Provider Name (Legal Business Name): NIAGARA PULMONARY AND SLEEP MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6941 ELAINE DR SUITE 2
NIAGARA FALLS NY
14304-2877
US

IV. Provider business mailing address

6941 ELAINE DR SUITE 2
NIAGARA FALLS NY
14304-2877
US

V. Phone/Fax

Practice location:
  • Phone: 716-298-8133
  • Fax: 716-298-8136
Mailing address:
  • Phone: 716-298-8133
  • Fax: 716-298-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number191202
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. EDWARD VENTRESCA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 716-298-8133