=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528233616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIE COUNTY MEDICAL CENTER CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2008
-----------------------------------------------------
Last Update Date | 12/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 462 GRIDER ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14215-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-898-3000
-----------------------------------------------------
Fax | 716-898-5178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 US ROUTE 9 NORTHWAY PLAZA SUITE 4F
-----------------------------------------------------
City | QUEENSBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12804-1766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. JONATHAN T SWIATKOWSKI
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 716-898-6291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------