Healthcare Provider Details

I. General information

NPI: 1891791976
Provider Name (Legal Business Name): SUMMIT PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6937 WILLIAMS RD
NIAGARA FALLS NY
14304-3022
US

IV. Provider business mailing address

6937 WILLIAMS RD
NIAGARA FALLS NY
14304-3022
US

V. Phone/Fax

Practice location:
  • Phone: 716-298-1107
  • Fax: 716-298-5737
Mailing address:
  • Phone: 716-298-1107
  • Fax: 716-298-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number166453
License Number StateNY

VIII. Authorized Official

Name: DR. TEJ N KAUL
Title or Position: PRESIDENT
Credential: MD
Phone: 716-298-1107