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General NPI Number Information
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NPI Number | 1770814519
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL HEALTH OF ALFRED, PLLC
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 28 CHURCH ST
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City | ALFRED
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State | NY
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Zip | 14802-1104
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Country | US
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Telephone | 607-587-8144
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SENECA ST
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City | HORNELL
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State | NY
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Zip | 14843-1312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ANDREA STILES
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Credential |
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Telephone | 607-324-5626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 201202-1
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License Number State | NY
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