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General NPI Number Information
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NPI Number | 1447212139
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Entity Type | Organization
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Legal Business Name | EAST AURORA PEDIATRICS
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 94 OLEAN ST
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City | EAST AURORA
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State | NY
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Zip | 14052-2531
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Country | US
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Telephone | 716-652-0237
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Fax | 716-652-0983
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Provider Business Mailing Address
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Address Line | 94 OLEAN ST
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City | EAST AURORA
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State | NY
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Zip | 14052-2531
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Country | US
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Telephone | 716-652-0237
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Fax | 716-652-0983
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Authorized Official
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Title or Position | CERTIFIED MEDICAL OFFICE MANAGER
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Name | BARBARA J JORDAN
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Credential |
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Telephone | 716-652-0237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State | NY
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