Provider Demographics
NPI:1649407131
Name:AMHERST COLON & RECTAL SURGERY, PLLC
Entity Type:Organization
Organization Name:AMHERST COLON & RECTAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOEHMKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-626-6626
Mailing Address - Street 1:8201 MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6046
Mailing Address - Country:US
Mailing Address - Phone:716-626-6626
Mailing Address - Fax:716-626-6646
Practice Address - Street 1:8201 MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6046
Practice Address - Country:US
Practice Address - Phone:716-626-6626
Practice Address - Fax:716-626-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130603208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty