Healthcare Provider Details

I. General information

NPI: 1427224625
Provider Name (Legal Business Name): WESTERN NEW YORK IMMEDIATE MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 ORCHARD PARK ROAD
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

PO BOX 5101
BUFFALO NY
14240-5101
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-4500
  • Fax: 716-204-4501
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-362-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number159276
License Number StateNY

VIII. Authorized Official

Name: GREGORY DANIEL
Title or Position: MD/OWNER
Credential: MD
Phone: 716-204-4500