Provider Demographics
NPI:1336113810
Name:NIAGARA PULMONARY AND SLEEP MEDICINE, P.C.
Entity Type:Organization
Organization Name:NIAGARA PULMONARY AND SLEEP MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTRESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-298-8133
Mailing Address - Street 1:6941 ELAINE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2877
Mailing Address - Country:US
Mailing Address - Phone:716-298-8133
Mailing Address - Fax:716-298-8136
Practice Address - Street 1:6941 ELAINE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2877
Practice Address - Country:US
Practice Address - Phone:716-298-8133
Practice Address - Fax:716-298-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191202173F00000X
207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1213Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER