Healthcare Provider Details

I. General information

NPI: 1679927339
Provider Name (Legal Business Name): KATIE KONESKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6044 MAIN ST STE 110
WILLIAMSVILLE NY
14221-6883
US

IV. Provider business mailing address

77 GOODELL ST STE 320
BUFFALO NY
14203-1243
US

V. Phone/Fax

Practice location:
  • Phone: 716-833-7112
  • Fax:
Mailing address:
  • Phone: 716-888-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number312455
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number312455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: