Healthcare Provider Details

I. General information

NPI: 1336111038
Provider Name (Legal Business Name): ROBERTA E GEBHARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

40 CARDINAL LN
GRAND ISLAND NY
14072-1950
US

V. Phone/Fax

Practice location:
  • Phone: 716-692-3302
  • Fax: 716-692-4342
Mailing address:
  • Phone: 716-649-0887
  • Fax: 716-646-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number176365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: