Healthcare Provider Details

I. General information

NPI: 1386729481
Provider Name (Legal Business Name): ORCHARD PARK PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 N BUFFALO ST SUITE A
ORCHARD PARK NY
14127-1853
US

IV. Provider business mailing address

3725 N BUFFALO ST SUITE A
ORCHARD PARK NY
14127-1853
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-2057
  • Fax:
Mailing address:
  • Phone: 716-662-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number149296
License Number StateNY

VIII. Authorized Official

Name: CHRISTINE B GURA
Title or Position: OFFICE MANAGER
Credential:
Phone: 716-662-2300