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General NPI Number Information
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NPI Number | 1598370975
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Entity Type | Organization
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Legal Business Name | LEGACY GYNECOLOGY PLLC
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 136 MAPLE RD
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City | AMHERST
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State | NY
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Zip | 14221-2922
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Country | US
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Telephone | 716-815-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 99 S ROCKINGHAM WAY
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City | AMHERST
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State | NY
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Zip | 14228-3723
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Country | US
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Telephone | 716-815-2400
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | KRISTEN SMYERS
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Credential | MD
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Telephone | 716-815-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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