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General NPI Number Information
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NPI Number | 1831260462
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Entity Type | Organization
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Legal Business Name | AMHERST SOUTHGATE, ENT, PLLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/27/2014
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Provider Practice Location Address
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Address Line | 1026 UNION RD
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City | WEST SENECA
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State | NY
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Zip | 14224-3449
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Country | US
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Telephone | 716-712-0855
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Fax | 716-712-0856
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Provider Business Mailing Address
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Address Line | 1026 UNION RD
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City | WEST SENECA
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State | NY
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Zip | 14224-3449
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Country | US
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Telephone | 716-712-0855
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Fax | 716-712-0856
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRIS DANZIGER
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Credential | M.D.
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Telephone | 716-712-0855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 177744
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License Number State | NY
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