Provider Demographics
NPI:1447025036
Name:WESTERN NEW YORK THORACIC SURGERY, LLC
Entity type:Organization
Organization Name:WESTERN NEW YORK THORACIC SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER WNYTS
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-462-4415
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-0007
Mailing Address - Country:US
Mailing Address - Phone:716-462-4415
Mailing Address - Fax:716-303-7008
Practice Address - Street 1:1093 DELAWARE AVE APT 5
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1655
Practice Address - Country:US
Practice Address - Phone:716-574-0396
Practice Address - Fax:716-303-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty