Healthcare Provider Details

I. General information

NPI: 1710299201
Provider Name (Legal Business Name): NIAGARA NEUROLOGICAL SERVICES AND SLEEP MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 MILITARY RD SUITE 101
LEWISTON NY
14092-2149
US

IV. Provider business mailing address

5320 MILITARY RD SUITE 101
LEWISTON NY
14092-2149
US

V. Phone/Fax

Practice location:
  • Phone: 716-575-0075
  • Fax: 716-242-0611
Mailing address:
  • Phone: 716-575-0075
  • Fax: 716-242-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH HELLIWELL
Title or Position: PRESIDENT
Credential: MD
Phone: 716-575-0075