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General NPI Number Information
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NPI Number | 1740479567
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Entity Type | Organization
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Legal Business Name | ERIE NIAGARA NEUROSURGERY PLLC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 18 LIMESTONE DR SUITE 2
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8602
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Country | US
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Telephone | 716-932-7170
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Fax | 716-932-7173
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Provider Business Mailing Address
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Address Line | PO BOX 439
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City | WEST FALLS
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State | NY
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Zip | 14170-0439
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Country | US
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Telephone | 716-932-7170
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Fax | 716-932-7173
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY JOHN BENNETT
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Credential | MD
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Telephone | 716-932-7170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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