MEDICARE: AMHERST NEUROLOGIC ASSOCIATES

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	2084N0400X	Neurology Physician	136790	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00010066701	OTHER	NY	UNIVERA
2	000507660001	OTHER	NY	BCBS
3	0501229	OTHER	NY	INDEPENDENT HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033263504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMHERST NEUROLOGIC ASSOCIATES

Provider Business Mailing Address
First Line	:	4140 SHERIDAN DRIVE
Second Line	:	SUITE 5
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-4341
Country	:	US
Telephone Number	:	716-634-2652
Fax Number	:	716-634-2653

Provider Business Practice Location Address
First Line	:	4140 SHERIDAN DRIVE
Second Line	:	SUITE 5
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-4341
Country	:	US
Telephone Number	:	716-634-2652
Fax Number	:	716-634-2653

Authorized Official
Title or Position	:	OWNER
Name	:	SVEND GOTHGEN
Credential	:	MD
Telephone Number	:	716-634-2652

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	06/25/2008

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