Healthcare Provider Details

I. General information

NPI: 1619256021
Provider Name (Legal Business Name): EMI A KODA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 SOUTHWESTERN BOULEVARD
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

3675 SOUTHWESTERN BOULEVARD
ORCHARD PARK NY
14127
US

V. Phone/Fax

Practice location:
  • Phone: 716-972-0279
  • Fax: 360-493-5524
Mailing address:
  • Phone: 716-972-0279
  • Fax: 716-972-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number290892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: