Healthcare Provider Details

I. General information

NPI: 1679293377
Provider Name (Legal Business Name): 716 HEALTH MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 DIVISION ST STE 1
NORTH TONAWANDA NY
14120-4631
US

IV. Provider business mailing address

273 DIVISION ST
NORTH TONAWANDA NY
14120-4631
US

V. Phone/Fax

Practice location:
  • Phone: 716-725-9000
  • Fax:
Mailing address:
  • Phone: 716-725-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATHALIE BOUSADER-ARMSTRONG
Title or Position: OWNER, MEDICAL DIRECTOR
Credential:
Phone: 716-725-9000