Provider Demographics
NPI:1063419513
Name:ENDOSCOPY CENTER OF WESTERN NEW YORK LLC
Entity type:Organization
Organization Name:ENDOSCOPY CENTER OF WESTERN NEW YORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-332-1000
Mailing Address - Street 1:60 MAPLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2917
Mailing Address - Country:US
Mailing Address - Phone:716-332-1000
Mailing Address - Fax:716-204-4549
Practice Address - Street 1:60 MAPLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2917
Practice Address - Country:US
Practice Address - Phone:716-332-1000
Practice Address - Fax:716-204-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
63056OtherAAAHC ACCREDIATION
NY465OtherBCBS ID
NY02578949Medicaid
NY141202ROtherOPERATING CERTIFICATE
NY465OtherBCBS ID