Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 279860 | NY |
NPI | 1003173022 |
---|---|
Provider Name | Angela Barnes |
First Address | West Seneca, NY 14224-3445 |
Second Address | Cheektowaga, NY 14227-1470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2012 |
Last Update Date | 15/09/2015 |