Provider Demographics
NPI:1396782645
Name:GREDZENS, ARIS (MD)
Entity type:Individual
Prefix:DR
First Name:ARIS
Middle Name:
Last Name:GREDZENS
Suffix:
Gender:M
Credentials:MD
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 STE 208
Mailing Address - Street 2:
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:716-213-0348
Practice Address - Street 1:159 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1013
Practice Address - Country:US
Practice Address - Phone:814-368-7777
Practice Address - Fax:814-362-8479
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447498207V00000X
WA20369207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04199639Medicaid
PA102786248Medicaid
WA1283803Medicaid
WAA08219Medicare UPIN
PA298823Medicare PIN
WAAO8219Medicare UPIN
NY04199639Medicaid