Healthcare Provider Details

I. General information

NPI: 1821058967
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF THE TONAWANDAS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 SHERIDAN DR
AMHERST NY
14226-1904
US

IV. Provider business mailing address

PO BOX 2461
BUFFALO NY
14240-2461
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-9345
  • Fax:
Mailing address:
  • Phone: 716-834-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED BALTI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 716-570-1064