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NPI Code Detail

MEDICARE: KENMORE PEDIATRIC ASSOC., P.C.

MEDICARE: KENMORE PEDIATRIC ASSOC., P.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
1208000000XPediatrics Physician111276NY

General Provider Information

NPI Number : 1215957063
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENMORE PEDIATRIC ASSOC., P.C.
Provider Business Mailing Address
First Line : 341 ENGLEWOOD AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14223-2819
Country : US
Telephone Number : 716-833-2333
Fax Number :
Provider Business Practice Location Address
First Line : 341 ENGLEWOOD AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14223-2819
Country : US
Telephone Number : 716-833-2333
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROGER A FORDEN
Credential : M.D.
Telephone Number : 716-833-2333
Provider Enumeration Date : 07/21/2006
Last Update Date : 08/22/2020

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