MEDICARE: WNY INTERNAL MEDICINE P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	212275	NY

General Provider Information

NPI Number	:	1124075908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WNY INTERNAL MEDICINE P.C.

Provider Business Mailing Address
First Line	:	445 TREMONT ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6150
Country	:	US
Telephone Number	:	716-690-2291
Fax Number	:	716-690-2369

Provider Business Practice Location Address
First Line	:	445 TREMONT ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6150
Country	:	US
Telephone Number	:	716-690-2291
Fax Number	:	716-690-2369

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	DR. GHOUS A YASIN
Credential	:	M.D.
Telephone Number	:	716-690-2291

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	12/12/2011

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