Healthcare Provider Details

I. General information

NPI: 1982595443
Provider Name (Legal Business Name): MR. IAN T BRILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

448 3RD AVE
BUFFALO NY
14221-4009
US

V. Phone/Fax

Practice location:
  • Phone: 716-645-2000
  • Fax:
Mailing address:
  • Phone: 516-417-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number828503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: