Provider Demographics
NPI:1568525871
Name:NIAGARA FALLS PHYSICIAN ASSOCIATES P.C.
Entity Type:Organization
Organization Name:NIAGARA FALLS PHYSICIAN ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VITELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-285-1133
Mailing Address - Street 1:620 - 10TH STREET
Mailing Address - Street 2:SUITE 710
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1841
Mailing Address - Country:US
Mailing Address - Phone:716-285-1133
Mailing Address - Fax:716-285-1179
Practice Address - Street 1:620 10TH ST
Practice Address - Street 2:SUITE 710
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1841
Practice Address - Country:US
Practice Address - Phone:716-285-1133
Practice Address - Fax:716-285-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157035207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00958970Medicaid
NY00958970Medicaid
NYB75441Medicare ID - Type Unspecified