Healthcare Provider Details

I. General information

NPI: 1326013152
Provider Name (Legal Business Name): RAYMOND ARTHUR NEISWONGER RN, ACNP, BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER STREET RM 741
BUFFALO NY
14215
US

IV. Provider business mailing address

6653 MAIN STREET
WILLIAMSVILLE NY
14221
US

V. Phone/Fax

Practice location:
  • Phone: 716-961-6995
  • Fax: 716-898-5276
Mailing address:
  • Phone: 716-204-4500
  • Fax: 716-204-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberF430228-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: