Healthcare Provider Details

I. General information

NPI: 1134294812
Provider Name (Legal Business Name): TONAWANDA MEDICAL PRACTICE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SWEET HOME RD SUITE# 6
WEST AMHERST NY
14228-1300
US

IV. Provider business mailing address

2800 SWEET HOME RD SUITE# 6
WEST AMHERST NY
14228-1300
US

V. Phone/Fax

Practice location:
  • Phone: 716-691-1300
  • Fax: 716-691-5044
Mailing address:
  • Phone: 716-691-1300
  • Fax: 716-691-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JIHAD HASSAN ABIALMOUNA
Title or Position: PHYSISIAN
Credential: M.D.
Phone: 716-691-1300