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General NPI Number Information
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NPI Number | 1518782168
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Entity Type | Organization
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Legal Business Name | SPINE AND PAIN PHYSICIANS OF WNY, PLLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 5959 BIG TREE RD. SUITE 101
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2291
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Country | US
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Telephone | 716-810-7997
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Fax | 716-242-0249
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Provider Business Mailing Address
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Address Line | 7 WOODBINE CT
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City | ORCHARD PARK
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State | NY
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Zip | 14127-3770
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Country | US
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Telephone | 716-480-1583
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH DITONTO
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Credential | MD
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Telephone | 716-480-1583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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