=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841788908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIWNY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2018
-----------------------------------------------------
Last Update Date | 04/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6631 MAIN ST STE 2
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-5934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-240-2296
-----------------------------------------------------
Fax | 716-462-6000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6044 WEXFORD MNR
-----------------------------------------------------
City | CLARENCE CENTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14032-9435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-309-9030
-----------------------------------------------------
Fax | 716-462-6000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SAMAN BAHRAM CHUBINEH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 716-240-2296
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 251164
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------