Healthcare Provider Details

I. General information

NPI: 1598806366
Provider Name (Legal Business Name): SUBURBAN PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8643 SHERIDAN DR
WILLIAMSVILLE NY
14221-6315
US

IV. Provider business mailing address

8643 SHERIDAN DR
WILLIAMSVILLE NY
14221-6315
US

V. Phone/Fax

Practice location:
  • Phone: 716-565-9030
  • Fax: 716-565-9038
Mailing address:
  • Phone: 716-565-9030
  • Fax: 716-565-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. G LAWRENCE MCNALLY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 716-565-9030