Provider Demographics
NPI:1619664125
Name:MOLE, SAMUEL LEONARD
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:LEONARD
Last Name:MOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2802
Mailing Address - Country:US
Mailing Address - Phone:716-535-0329
Mailing Address - Fax:
Practice Address - Street 1:4635 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1851
Practice Address - Country:US
Practice Address - Phone:716-633-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY49754101163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice