Healthcare Provider Details

I. General information

NPI: 1215906383
Provider Name (Legal Business Name): WILLIAM FIDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 KENSINGTON AVE
BUFFALO NY
14215
US

IV. Provider business mailing address

462 GRIDER ST BLDG CC
BUFFALO NY
14215
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-8612
  • Fax: 716-831-8649
Mailing address:
  • Phone: 716-898-6206
  • Fax: 716-898-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: