Provider Demographics
NPI:1831152701
Name:KINKEL, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KINKEL
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 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:5 LIMESTONE DR
Practice Address - Street 2:SUITE B
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7178
Practice Address - Country:US
Practice Address - Phone:716-632-9399
Practice Address - Fax:716-632-7742
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144507207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000525431011OtherBLUE SHIELD OF WESTERN NY
000525431012OtherBLUE SHIELD OF WESTERN NY
NY1525351WOtherWORKERS COMPENSATION
050701000002OtherFIDELIS
1605752OtherINDEPENDENT HEALTH
NY00903993Medicaid
NYDD6873Medicare PIN
050701000002OtherFIDELIS
1605752OtherINDEPENDENT HEALTH