Healthcare Provider Details

I. General information

NPI: 1740733575
Provider Name (Legal Business Name): NR PHYSICIAN GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 N BUFFALO ST
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-5782
US

V. Phone/Fax

Practice location:
  • Phone: 716-817-5590
  • Fax:
Mailing address:
  • Phone: 716-817-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ZIELINSKI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 716-630-1219