Provider Demographics
NPI:1033263504
Name:AMHERST NEUROLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:AMHERST NEUROLOGIC ASSOCIATES
Other - Org Name:SVEND GOTHGEN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SVEND
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTHGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-634-2652
Mailing Address - Street 1:4140 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4341
Mailing Address - Country:US
Mailing Address - Phone:716-634-2652
Mailing Address - Fax:716-634-2653
Practice Address - Street 1:4140 SHERIDAN DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4341
Practice Address - Country:US
Practice Address - Phone:716-634-2652
Practice Address - Fax:716-634-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1367902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010066701OtherUNIVERA
NY000507660001OtherBCBS
NY0501229OtherINDEPENDENT HEALTH
NY00619076Medicaid
NY0501229OtherINDEPENDENT HEALTH
B71004Medicare UPIN