Eastern Niagara Medical Group

NPI #1346796398 in Lockport, New York

Provider Information

NPI Number: 1346796398
Entity Type: Organization
Organization Name: Eastern Niagara Medical Group
Subpart: Yes (part of a larger organization)
Parent Organization: EASTERN NIAGARA HOSPITAL, INC
Primary Specialty: Family Medicine
Enumeration Date: Aug 30, 2016
Last Updated: Sep 1, 2016

Practice Location

Address: 53 ELIZABETH DR
City: Lockport
State: New York
ZIP Code: 14094-5226
Phone: (716) 514-5501

Authorized Official

Name: MR. MICHAEL FRANCIS ICKOWSKI SR., MBA, CPA
Title: CFO
Phone: (716) 514-5501

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X
Internal Medicine - Gastroenterology — Gastroenterology	207RG0100X
Family Medicine	207Q00000X	Primary

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