Provider Demographics
NPI:1376129015
Name:MEDICAL PRACTITIONER SERVICES OF WNY PC
Entity type:Organization
Organization Name:MEDICAL PRACTITIONER SERVICES OF WNY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:716-553-1343
Mailing Address - Street 1:1219 NORTH FOREST ROAD
Mailing Address - Street 2:C/O MEDICAL PRACTITIONER SERVICES OF WNY PC
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 HERTEL AVE # 101
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1906
Practice Address - Country:US
Practice Address - Phone:716-566-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services