MEDICARE: REZA BANIFATEMI MD

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	207RC0000X	Cardiovascular Disease Physician	262789	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205884533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REZA BANIFATEMI MD

Provider Business Mailing Address
First Line	:	908 NIAGARA FALLS BLVD STE 208
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2019
Country	:	US
Telephone Number	:	716-692-3302
Fax Number	:	716-692-4342

Provider Business Practice Location Address
First Line	:	705 MAPLE RD STE 300
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-3291
Country	:	US
Telephone Number	:	716-710-8266
Fax Number	:	716-710-8267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	11/08/2017

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Directions to “ REZA BANIFATEMI MD” Practice Location

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