Provider Demographics
NPI:1396075560
Name:MOBILE ULTRASOUND OF WNY, LLC
Entity type:Organization
Organization Name:MOBILE ULTRASOUND OF WNY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GESTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-636-7666
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-0627
Mailing Address - Country:US
Mailing Address - Phone:716-636-7666
Mailing Address - Fax:716-639-1317
Practice Address - Street 1:22 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1243
Practice Address - Country:US
Practice Address - Phone:716-636-7666
Practice Address - Fax:716-639-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty