Provider Demographics
NPI:1104085828
Name:WNY ADULT AND CHILD NEUROLOGY, PC
Entity type:Organization
Organization Name:WNY ADULT AND CHILD NEUROLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROVNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-404-2604
Mailing Address - Street 1:4772 N FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2176
Mailing Address - Country:US
Mailing Address - Phone:716-404-2604
Mailing Address - Fax:716-404-2692
Practice Address - Street 1:4772 N FRENCH RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1427
Practice Address - Country:US
Practice Address - Phone:716-404-2604
Practice Address - Fax:716-404-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238610-1261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027713002OtherUNIVERA HEALTHCARE
NY0514007OtherINDEPENDENT HEALTH
NY00027713002OtherUNIVERA HEALTHCARE