Provider Demographics
NPI:1609583228
Name:GJKS PHYSICIAN, PC
Entity Type:Organization
Organization Name:GJKS PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-236-7880
Mailing Address - Street 1:4515 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1335
Mailing Address - Country:US
Mailing Address - Phone:716-236-7880
Mailing Address - Fax:716-236-7885
Practice Address - Street 1:4515 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1335
Practice Address - Country:US
Practice Address - Phone:716-236-7880
Practice Address - Fax:716-236-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty