Provider Demographics
NPI:1588118954
Name:PEDIATRIC PSYCHOLOGY & MEDICINE OF WESTERN NEW YORK, PLLC
Entity type:Organization
Organization Name:PEDIATRIC PSYCHOLOGY & MEDICINE OF WESTERN NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:716-837-3415
Mailing Address - Street 1:112 BONDCROFT DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3427
Mailing Address - Country:US
Mailing Address - Phone:716-837-3415
Mailing Address - Fax:
Practice Address - Street 1:2625 HARLEM RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-837-3415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012466103TC2200X
NY2824792080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty