Healthcare Provider Details

I. General information

NPI: 1164458345
Provider Name (Legal Business Name): RIVER PARK FAMILY MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 RIVER RD SUITE 1
NORTH TONAWANDA NY
14120-6563
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD SUITE 208
NORTH TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-693-2464
  • Fax: 716-693-9022
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH RESZEL
Title or Position: PRESIDENT
Credential: MD
Phone: 716-693-2464