Healthcare Provider Details

I. General information

NPI: 1609569441
Provider Name (Legal Business Name): ISNA HIRA KHALIQ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 MAIN ST STE 7230
BUFFALO NY
14203-1121
US

IV. Provider business mailing address

955 MAIN ST STE 7230
BUFFALO NY
14203-1121
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number125.082068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: