Healthcare Provider Details

I. General information

NPI: 1447351259
Provider Name (Legal Business Name): PAIN MANAGEMENT AND HEADACHE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 MAIN ST SUITE 112
BUFFALO NY
14214-2693
US

IV. Provider business mailing address

338 HARRIS HILL RD SUITE 207
WILLIAMSVILLE NY
14221-7407
US

V. Phone/Fax

Practice location:
  • Phone: 716-832-1107
  • Fax: 716-832-1108
Mailing address:
  • Phone: 716-634-4798
  • Fax: 716-634-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number236106
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number236106
License Number StateNY

VIII. Authorized Official

Name: DR. ASHRAF F HENRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 716-634-4798