Healthcare Provider Details

I. General information

NPI: 1821283656
Provider Name (Legal Business Name): SUWARNA NAIK PHYSICIAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4156 W MAIN STREET RD
BATAVIA NY
14020-1291
US

IV. Provider business mailing address

4156 W MAIN STREET RD
BATAVIA NY
14020-1291
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-0870
  • Fax: 585-345-1420
Mailing address:
  • Phone: 585-344-0870
  • Fax: 585-345-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1690021
License Number StateNY

VIII. Authorized Official

Name: REBECCA NICOMETI
Title or Position: FINANCIAL OFFICER
Credential:
Phone: 585-344-0870