Healthcare Provider Details

I. General information

NPI: 1588490759
Provider Name (Legal Business Name): DR. USAMA NASSAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SQUIRE HALL
BUFFALO NY
14214-8006
US

IV. Provider business mailing address

215 SQUIRE HALL
BUFFALO NY
14214-8006
US

V. Phone/Fax

Practice location:
  • Phone: 716-547-2828
  • Fax:
Mailing address:
  • Phone: 716-547-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number000157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: