Healthcare Provider Details
I. General information
NPI: 1487877817
Provider Name (Legal Business Name): WESTERN NEW YORK EAR, NOSE & THROAT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/11/2007
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3670 SOUTH BENZING SUITE C
ORCHARD PARK NY
14127
US
IV. Provider business mailing address
3670 SOUTH BENZING SUITE C
ORCHARD PARK NY
14127
US
V. Phone/Fax
- Phone: 716-675-5711
- Fax: 716-675-1358
- Phone: 716-675-5711
- Fax: 716-675-1358
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207YX0905X |
| Taxonomy | Otolaryngology/Facial Plastic Surgery Physician |
| License Number | 156731 |
| License Number State | NY |
VIII. Authorized Official
Name: DR.
NATALKA
DARIA
STACHIW
Title or Position: OWNER
Credential: M.D.
Phone: 716-675-5711