Basic Information
| Provider Information | |||||||||
| NPI: | 1457884470 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHGATE MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 YOUNGS RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166367990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3950 E ROBINSON RD STE 207 | ||||||||
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| City: | WEST AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142282044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165641111 | ||||||||
| FaxNumber: | 7169290194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | DLUGOSZ | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 7166367979 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 020629 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.