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General NPI Number Information
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NPI Number | 1295924363
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Entity Type | Organization
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Legal Business Name | TONAWANDA MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 843 TONAWANDA ST
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City | BUFFALO
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State | NY
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Zip | 14207-1447
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Country | US
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Telephone | 716-536-9409
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Fax | 716-874-6660
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Provider Business Mailing Address
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Address Line | PO BOX 1015
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City | BUFFALO
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State | NY
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Zip | 14207-9015
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Country | US
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Telephone | 716-536-9409
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Fax | 716-689-4961
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ZIAD I KHATIB
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Credential | M.D.
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Telephone | 716-536-9409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 214045
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 214045
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License Number State | NY
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