Healthcare Provider Details

I. General information

NPI: 1487889804
Provider Name (Legal Business Name): GENESEE VALLEY PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S CLINTON AVE
ROCHESTER NY
14618-5727
US

IV. Provider business mailing address

2050 SOUTH CLINTON AVENUE
ROCHESTER NY
14618
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-4280
  • Fax: 585-271-4311
Mailing address:
  • Phone: 585-271-4280
  • Fax: 585-271-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number130235
License Number StateNJ

VIII. Authorized Official

Name: DR. NASEER A TAHIR
Title or Position: OWNER
Credential: M.D.
Phone: 585-271-4280