Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 027835-01 | NY |
Y | 111NI0900X | Internist | 027835-01 | NY |
NPI | 1003567603 |
---|---|
Provider Name | Colleen Klos |
First Address | Williamsville, NY 14221-3647 |
Second Address | Williamsville, NY 14221-3647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2022 |
Last Update Date | 14/01/2022 |