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General NPI Number Information
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NPI Number | 1245506633
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Entity Type | Individual
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Provider Name | NICHOLAS JOSEPH WATSON RPAC
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Gender | Male
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 6 FOUNTAIN PLZ
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City | BUFFALO
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State | NY
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Zip | 14202-2211
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Country | US
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Telephone | 716-580-1815
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Fax | 716-580-1134
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Provider Business Mailing Address
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Address Line | 6 FOUNTAIN PLZ
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City | BUFFALO
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State | NY
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Zip | 14202-2211
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Country | US
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Telephone | 716-508-0866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 015525
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License Number State | NY
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