Healthcare Provider Details

I. General information

NPI: 1629294806
Provider Name (Legal Business Name): NIKITA CHANDRAKANT DAVE MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 HERTEL AVE. INDUSTRIAL MEDICINE OFFICE
BUFFALO NY
14216
US

IV. Provider business mailing address

195 KOENIG RD
TONAWANDA NY
14150-7532
US

V. Phone/Fax

Practice location:
  • Phone: 914-323-0312
  • Fax:
Mailing address:
  • Phone: 716-833-9498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number228502
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME98345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: