Healthcare Provider Details

I. General information

NPI: 1255309647
Provider Name (Legal Business Name): ROSS A. HORSLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 N 9TH ST
OLEAN NY
14760-2214
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 716-806-0350
  • Fax: 716-806-0365
Mailing address:
  • Phone: 716-692-2160
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number153020
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number153020
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: