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General NPI Number Information
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NPI Number | 1184670283
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Entity Type | Organization
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Legal Business Name | DOCTOR HANY G NISSIEM FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 6565 FOURTH SECTION RD SUITE 300
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City | BROCKPORT
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State | NY
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Zip | 14420-2414
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Country | US
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Telephone | 585-395-0620
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Fax | 585-395-0622
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Provider Business Mailing Address
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Address Line | 6565 FOUTH SECTION RD SUITE 300
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City | BROCKPORT
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State | NY
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Zip | 14420-2416
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Country | US
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Telephone | 585-395-0620
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Fax | 585-395-0622
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Authorized Official
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Title or Position | OWNER
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Name | HANY NISSIEM
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Credential | M.D.
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Telephone | 585-395-0620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 227675
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License Number State | NY
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