Healthcare Provider Details

I. General information

NPI: 1124256367
Provider Name (Legal Business Name): JASON THOMAS REIN ANP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON ST
BUFFALO NY
14263-1426
US

IV. Provider business mailing address

1300 ELMWOOD AVE
BUFFALO NY
14222-1004
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-8223
Mailing address:
  • Phone: 716-878-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305132
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number305132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: