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General NPI Number Information
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NPI Number | 1780076943
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Entity Type | Organization
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Legal Business Name | KOSTAS N BOTSOGLOU MD LLC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 2475 HARLEM RD
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-4558
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Country | US
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Telephone | 716-322-5428
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Fax |
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Provider Business Mailing Address
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Address Line | 2475 HARLEM RD
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-4558
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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 | OWNER
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Name | KOSTAS N BOTSOGLOU
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Credential |
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Telephone | 716-863-1432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 262576
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License Number State | NY
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