Healthcare Provider Details

I. General information

NPI: 1063471407
Provider Name (Legal Business Name): JILL ELLEN HESS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ESSJAY RD
WILLIAMSVILLE NY
14221-8216
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-8235
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1050
  • Fax:
Mailing address:
  • Phone: 716-630-1219
  • Fax: 716-817-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006528-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: