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General NPI Number Information
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NPI Number | 1194411629
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Entity Type | Organization
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Legal Business Name | HAIR RESTORATION & AESTHETICS OF BUFFALO
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 777 MAPLE RD STE 4&5
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3275
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Country | US
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Telephone | 716-500-4247
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Fax | 716-428-3890
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Provider Business Mailing Address
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Address Line | 777 MAPLE RD STE 4&5
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3275
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Country | US
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Telephone | 716-500-4247
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Fax | 716-428-3890
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | LORI NICHOLAS
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Credential |
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Telephone | 716-870-0437
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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 |
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License Number State |
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