Healthcare Provider Details

I. General information

NPI: 1275727828
Provider Name (Legal Business Name): CHILDREN'S E.N.T., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 MAIN STREET STE 5
WILLIAMSVILLE NY
14221
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD STE 208
N TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-362-9730
  • Fax: 716-213-0348
Mailing address:
  • Phone: 716-692-2160
  • Fax: 716-332-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number168257
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number168257
License Number StateNY

VIII. Authorized Official

Name: MICHAEL PAUL PIZZUTO
Title or Position: OWNER
Credential: MD
Phone: 716-632-2000