Provider Demographics
NPI:1578803631
Name:FEDERICO GONZALEZ-DOLDAN, M.D., P.C.
Entity Type:Organization
Organization Name:FEDERICO GONZALEZ-DOLDAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-DOLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-693-5005
Mailing Address - Street 1:585 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:585 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5300
Practice Address - Country:US
Practice Address - Phone:716-693-5005
Practice Address - Fax:716-693-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117488207Y00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0069618Medicaid
NY0069618Medicaid
NY066695Medicare PIN