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General NPI Number Information
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NPI Number | 1548354335
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Entity Type | Organization
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Legal Business Name | EMG SPINE AND SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 80 MEAD ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-4435
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Country | US
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Telephone | 716-692-4020
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Fax | 716-692-5090
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Provider Business Mailing Address
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Address Line | 338 HARRIS HILL ROAD SUITE 207
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221
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Country | US
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Telephone | 716-634-4798
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Fax | 716-634-0987
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAHIR M QAZI
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Credential | M.D.
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Telephone | 716-692-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 236351-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 236351
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License Number State | NY
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