Provider Demographics
NPI:1295873420
Name:PHYSICIAN ASSISTANTS OF WESTERN NEW YORK
Entity type:Organization
Organization Name:PHYSICIAN ASSISTANTS OF WESTERN NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:716-668-6343
Mailing Address - Street 1:657 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1414
Mailing Address - Country:US
Mailing Address - Phone:716-884-3937
Mailing Address - Fax:
Practice Address - Street 1:327 BORDEN AVE
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14222
Practice Address - Country:US
Practice Address - Phone:716-668-6343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005914261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local