Provider Demographics
NPI:1568647337
Name:WILLIAMSVILLE OBSTETRICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:WILLIAMSVILLE OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:COPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-634-3316
Mailing Address - Street 1:30 NORTH UNION ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-634-3316
Mailing Address - Fax:716-632-7822
Practice Address - Street 1:30 NORTH UNION ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-634-3316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAMSVILLE OBSTETRICS AND GYNECOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089969207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14124BMedicare PIN
B71138Medicare UPIN