Organization · Type 2 NPI
General Physician, PC
Clinic/Center · Ellicottville, NY
NPI number
1003566233
Active
Practice location
6133 Route 219 S Ste 1006
Ellicottville, NY 14731-9613
Mailing address
535 Main St
Olean, NY 14760-1500
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinic/Center Primary | 261Q00000X | None listed |
Clinic/Center: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
About NPI 1003566233
General Physician, PC's National Provider Identifier is 1003566233, issued on Mar 29, 2022. The primary taxonomy on file is Clinic/Center (261Q00000X), and the practice location is in Ellicottville, NY. The record was last updated on Jun 8, 2026.