Doctor Name: | JENNIFER GURSKE-DEPERIO |
NPI Number: | 1972768042 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | |
Business Practice Address: | 5959 Big Tree Rd Orchard Park, NY - 141272291 |
Business Phone Number: | 7168214400 |
Business Fax Number: | 7168292138 |
Mailing Address: | 5500 Main St, Suite 107 WILLIAMSVILLE |
State: | NY |
Postal Code: | 142216755 |
Phone Number: | 7169065908 |
Fax Number: | |
NPI Enumeration Date: | 07/28/2008 |
NPI Last Update Date: | 11/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |