MEDICARE: LEAH VANDENBOSCH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1013640564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH VANDENBOSCH PA-C

Provider Business Mailing Address
First Line	:	7230 MEADOWVIEW DR
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-6267
Country	:	US
Telephone Number	:	716-255-0523
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 MAPLE RD STE 100
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-4080
Country	:	US
Telephone Number	:	716-839-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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