Provider Demographics
NPI:1518782168
Name:SPINE AND PAIN PHYSICIANS OF WNY, PLLC
Entity type:Organization
Organization Name:SPINE AND PAIN PHYSICIANS OF WNY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DITONTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-480-1583
Mailing Address - Street 1:7 WOODBINE CT
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3770
Mailing Address - Country:US
Mailing Address - Phone:716-480-1583
Mailing Address - Fax:
Practice Address - Street 1:5959 BIG TREE RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2291
Practice Address - Country:US
Practice Address - Phone:716-810-7997
Practice Address - Fax:716-242-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty