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General NPI Number Information
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NPI Number | 1114915287
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Entity Type | Individual
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Provider Name | LYNNE MARIE FRIES PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 219 BRYANT STREET
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City | BUFFALO
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State | NY
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Zip | 14222-2006
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Country | US
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Telephone | 716-250-6545
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Fax | 716-250-6566
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Provider Business Mailing Address
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Address Line | 4511 HARLEM ROAD SUITE 202
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City | AMHERST
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State | NY
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Zip | 14226-3822
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Country | US
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Telephone | 716-839-6720
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Fax | 716-839-6740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 006966-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 006966
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License Number State | NY
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