Healthcare Provider Details

I. General information

NPI: 1497922306
Provider Name (Legal Business Name): DARLENE W GOLIBERSUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MAIN ST
WESTFIELD NY
14787-1306
US

IV. Provider business mailing address

105 E MAIN ST
WESTFIELD NY
14787-1306
US

V. Phone/Fax

Practice location:
  • Phone: 716-793-2020
  • Fax: 716-793-3030
Mailing address:
  • Phone: 716-793-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number005045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: