Basic Information
| Provider Information | |||||||||
| NPI: | 1992336267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANE | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | BRIDGET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142132001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168840070 | ||||||||
| FaxNumber: | 7168840631 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142132001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168840700 | ||||||||
| FaxNumber: | 7168840631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2020 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 289294 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.