Healthcare Provider Details

I. General information

NPI: 1295078202
Provider Name (Legal Business Name): EXCELSIOR ORTHOPAEDICS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/10/2022
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 NIAGARA FALLS BLVD STE 2
NIAGARA FALLS NY
14304-2941
US

IV. Provider business mailing address

3925 SHERIDAN DR
AMHERST NY
14226-1738
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-9999
  • Fax:
Mailing address:
  • Phone: 716-250-9999
  • Fax: 716-250-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA LASKI
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 716-250-6409