Healthcare Provider Details

I. General information

NPI: 1548238538
Provider Name (Legal Business Name): ANDREW BRUCE SYMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 SHERIDAN DRIVE
TONAWANDA NY
14150-9407
US

IV. Provider business mailing address

77 GOODELL STREET STE 240
BUFFALO NY
14203-1243
US

V. Phone/Fax

Practice location:
  • Phone: 716-835-9800
  • Fax: 716-835-9888
Mailing address:
  • Phone: 716-645-9694
  • Fax: 716-845-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number231206
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number231206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: