Basic Information
| Provider Information | |||||||||
| NPI: | 1285855536 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAMSVILLE ORTHOPEDIC SURGERY,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 S FOREST RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142216425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166313041 | ||||||||
| FaxNumber: | 7166315380 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 S FOREST RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142216425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166313041 | ||||||||
| FaxNumber: | 7166315380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILD | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7166313041 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 137730 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.