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General NPI Number Information
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NPI Number | 1669422697
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Entity Type | Organization
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Legal Business Name | EASTERN NIAGARA OB/GYN, PC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | 175 WALNUT ST. SUITE 7
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City | LOCKPORT
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State | NY
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Zip | 14094-3775
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Country | US
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Telephone | 716-433-1941
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Fax | 716-439-1233
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Provider Business Mailing Address
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Address Line | 175 WALNUT ST. SUITE 7
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City | LOCKPORT
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State | NY
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Zip | 14094-3775
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Country | US
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Telephone | 716-433-1941
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Fax | 716-439-1233
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROGER G JAMMAL
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Credential | MD
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Telephone | 716-433-1941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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