Most Relevant Information
Provider Data
| NPI Number: | 1003217514 |
| Provider Name: | KELLY GORDON |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/16/2014 |
| Last Updated: | 09/16/2014 |
Provider Practice Location
1280 MAIN ST
BUFFALO
NY
142091912
Practice Location Phone/Fax
| Phone: | 7168824357 |
| Fax: | 7168820293 |
Provider Mailing Location
227 THORN AVE
ORCHARD PARK
NY
141272600
Provider Mailing Phone/Fax
| Phone: | 7166622040 |
| Fax: | 7166620019 |