Healthcare Provider Details

I. General information

NPI: 1063419513
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF WESTERN NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MAPLE RD SUITE 2
WILLIAMSVILLE NY
14221-2917
US

IV. Provider business mailing address

60 MAPLE RD STE 2
WILLIAMSVILLE NY
14221-2917
US

V. Phone/Fax

Practice location:
  • Phone: 716-332-1000
  • Fax: 716-204-4549
Mailing address:
  • Phone: 716-332-1000
  • Fax: 716-204-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAT GRAHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 716-332-1000