Provider Demographics
NPI:1275963043
Name:ROEHMHOLDT NEUROLOGY PC
Entity Type:Organization
Organization Name:ROEHMHOLDT NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROEHMHOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-634-6357
Mailing Address - Street 1:300 ESSJAY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8208
Mailing Address - Country:US
Mailing Address - Phone:716-634-6357
Mailing Address - Fax:716-634-3448
Practice Address - Street 1:300 ESSJAY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8208
Practice Address - Country:US
Practice Address - Phone:716-634-6357
Practice Address - Fax:716-634-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1280362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty