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General NPI Number Information
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NPI Number | 1417157793
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Entity Type | Organization
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Legal Business Name | PRESTON MEDICAL, P.C.
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 2162 MAIN ST
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City | BUFFALO
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State | NY
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Zip | 14214-2634
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Country | US
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Telephone | 716-204-1180
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Fax | 716-834-5507
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Provider Business Mailing Address
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Address Line | 267 LONDONDERRY LN
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City | GETZVILLE
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State | NY
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Zip | 14068-1182
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Country | US
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Telephone | 716-204-1180
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Fax | 716-834-5507
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Authorized Official
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Title or Position | CEO
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Name | ADEBUKOLA ABIOLA
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Credential | M.D.
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Telephone | 716-204-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 225100
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License Number State | NY
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