Provider Demographics
NPI:1033694294
Name:WNY PEDIATRIC ENDOCRINOLOGY, PLLC
Entity Type:Organization
Organization Name:WNY PEDIATRIC ENDOCRINOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADEZHDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANILOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-201-7112
Mailing Address - Street 1:5762 E MAIN STREET RD STE B
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9621
Mailing Address - Country:US
Mailing Address - Phone:585-201-7112
Mailing Address - Fax:585-201-7128
Practice Address - Street 1:5762 E MAIN STREET RD STE B
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9621
Practice Address - Country:US
Practice Address - Phone:585-201-7112
Practice Address - Fax:585-201-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000529154002OtherBCBS WNY
1214181OtherINDEPENDENT HEALTH
NY02852904Medicaid