Provider Demographics
NPI:1225280217
Name:VIVIAN L. LINDFIELD, MD, PC
Entity Type:Organization
Organization Name:VIVIAN L. LINDFIELD, MD, PC
Other - Org Name:WESTERN NEW YORK BREAST HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINDFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-632-7465
Mailing Address - Street 1:180 PARK CLUB LANE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5258
Mailing Address - Country:US
Mailing Address - Phone:716-632-7465
Mailing Address - Fax:716-632-7464
Practice Address - Street 1:180 PARK CLUB LANE, SUITE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5258
Practice Address - Country:US
Practice Address - Phone:716-632-7465
Practice Address - Fax:716-632-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253905208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02504772Medicaid
NYH95322Medicare UPIN
NY02504772Medicaid