Provider Demographics
NPI:1558882175
Name:MEDICAL PRACTICE OF NIAGARA PC
Entity Type:Organization
Organization Name:MEDICAL PRACTICE OF NIAGARA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-514-5227
Mailing Address - Street 1:521 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 WALNUT ST STE 7
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3775
Practice Address - Country:US
Practice Address - Phone:716-433-1941
Practice Address - Fax:716-439-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty