Provider Demographics
NPI:1003174921
Name:GENERAL PHYSICIAN SUB II PLLC
Entity Type:Organization
Organization Name:GENERAL PHYSICIAN SUB II PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MINEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-859-8831
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-8000
Mailing Address - Country:US
Mailing Address - Phone:203-944-1940
Mailing Address - Fax:203-402-4192
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:RM C421
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-7607
Practice Address - Fax:716-859-2885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERAL PHYSICIAN, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-28
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty