Provider Demographics
NPI:1518023613
Name:PEDIATRIC CARDIOLOGY ASSOCIATES OF WNY, LLC
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY ASSOCIATES OF WNY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-885-5437
Mailing Address - Street 1:936 DELAWARE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1804
Mailing Address - Country:US
Mailing Address - Phone:716-885-5437
Mailing Address - Fax:
Practice Address - Street 1:936 DELAWARE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1804
Practice Address - Country:US
Practice Address - Phone:716-885-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0147OtherMEDICARE PTAN