Healthcare Provider Details

I. General information

NPI: 1841615200
Provider Name (Legal Business Name): NEHA JASSAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 BROADWAY ST
BUFFALO NY
14212-1460
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-852-1578
  • Fax: 716-852-5154
Mailing address:
  • Phone: 716-323-0034
  • Fax: 716-323-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number286223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: