Healthcare Provider Details

I. General information

NPI: 1780246777
Provider Name (Legal Business Name): WNY MEDICAL PC - CARE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4979 HARLEM RD
AMHERST NY
14226-2547
US

IV. Provider business mailing address

5792 MAIN ST
WILLIAMSVILLE NY
14221-5702
US

V. Phone/Fax

Practice location:
  • Phone: 716-923-4380
  • Fax:
Mailing address:
  • Phone: 716-923-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: RIFFAT SADIQ
Title or Position: PRESIDENT
Credential: MD
Phone: 716-923-4380