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General NPI Number Information
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NPI Number | 1295873420
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Entity Type | Organization
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Legal Business Name | PHYSICIAN ASSISTANTS OF WESTERN NEW YORK
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 327 BORDEN AVE
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City | WEST SENECA
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State | NY
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Zip | 14222
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Country | US
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Telephone | 716-668-6343
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Fax |
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Provider Business Mailing Address
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Address Line | 657 AUBURN AVE
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City | BUFFALO
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State | NY
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Zip | 14222-1414
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Country | US
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Telephone | 716-884-3937
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MR. TODD ROLAND
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Credential | PHYSICIAN ASSISTANT
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Telephone | 716-668-6343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number | 005914
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License Number State | NY
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