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NPI Code Detail

MEDICARE: ROBERT F DIVENCENZO D.O.

MEDICARE: ROBERT F DIVENCENZO D.O.
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
1207R00000XInternal Medicine Physician188929-1NY

General Provider Information

NPI Number : 1467450833
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT F DIVENCENZO D.O.
Provider Business Mailing Address
First Line : 908 NIAGARA FALLS BLVD
Second Line : SUITE 208
City : N TONAWANDA
State : NY
Zip : 14120-2019
Country : US
Telephone Number : 716-692-3302
Fax Number : 716-692-4342
Provider Business Practice Location Address
First Line : 5300 MILITARY RD
Second Line :
City : LEWISTON
State : NY
Zip : 14092-1903
Country : US
Telephone Number : 716-298-3782
Fax Number : 716-692-4342
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 11/08/2007

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