Healthcare Provider Details

I. General information

NPI: 1598718983
Provider Name (Legal Business Name): TAJUDDIN MUHAMMAD JIVA MD MPH MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 WEHRLE DR STE 11A
WILLIAMSVILLE NY
14221-7387
US

IV. Provider business mailing address

2829 WEHRLE DR STE 11A
WILLIAMSVILLE NY
14221-7387
US

V. Phone/Fax

Practice location:
  • Phone: 716-836-1388
  • Fax: 716-836-1399
Mailing address:
  • Phone: 716-334-9879
  • Fax: 716-836-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number183042
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: