Provider Demographics
NPI:1477619732
Name:GYNECOLOGIC ONCOLOGY ASSOCIATES OF WESTERN NEW YORK PC
Entity Type:Organization
Organization Name:GYNECOLOGIC ONCOLOGY ASSOCIATES OF WESTERN NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-689-8519
Mailing Address - Street 1:1020 YOUNGS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2642
Mailing Address - Country:US
Mailing Address - Phone:716-689-8519
Mailing Address - Fax:716-689-7062
Practice Address - Street 1:1020 YOUNGS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2642
Practice Address - Country:US
Practice Address - Phone:716-689-8519
Practice Address - Fax:716-689-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14428AMedicare PIN