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General NPI Number Information
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NPI Number | 1679293377
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Entity Type | Organization
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Legal Business Name | 716 HEALTH MEDICAL, PLLC
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 273 DIVISION ST STE 1
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-4631
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Country | US
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Telephone | 716-725-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 273 DIVISION ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-4631
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Country | US
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Telephone | 716-725-9000
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Fax |
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Authorized Official
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Title or Position | OWNER, MEDICAL DIRECTOR
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Name | NATHALIE BOUSADER-ARMSTRONG
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Credential |
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Telephone | 716-725-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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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 |
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License Number State |
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