Healthcare Provider Details

I. General information

NPI: 1508802620
Provider Name (Legal Business Name): JUSTIN C KANALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 E ROBINSON RD SUITE 205
WEST AMHERST NY
14228-2041
US

IV. Provider business mailing address

3960 EAST ROBINSON ROAD SUITE 205
WEST AMHERST NY
14228-2041
US

V. Phone/Fax

Practice location:
  • Phone: 716-691-3400
  • Fax: 716-691-3404
Mailing address:
  • Phone: 716-691-3400
  • Fax: 716-691-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number239741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: