Provider Demographics
NPI:1194771477
Name:CARDIOLOGY GROUP OF WESTERN NEW YORK PC
Entity type:Organization
Organization Name:CARDIOLOGY GROUP OF WESTERN NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER/CMC
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-634-3502
Mailing Address - Street 1:825 WEHRLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-634-3502
Mailing Address - Fax:716-634-1930
Practice Address - Street 1:825 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7717
Practice Address - Country:US
Practice Address - Phone:716-634-3243
Practice Address - Fax:716-634-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104448207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01456019Medicaid
NY015261Medicare PIN
NY01456019Medicaid