1578982781 NPI number — WARREN PAIN CLINIC AND ACUPUNCTURE CENTER, PC

Table of content: (NPI 1578982781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578982781 NPI number — WARREN PAIN CLINIC AND ACUPUNCTURE CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN PAIN CLINIC AND ACUPUNCTURE CENTER, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578982781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 NIAGARA FALLS BLVD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
NORTH TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14120-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-692-2160
Provider Business Mailing Address Fax Number:
716-213-0935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 FOOTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-6941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-487-0911
Provider Business Practice Location Address Fax Number:
716-483-4645
Provider Enumeration Date:
04/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KOURTU
Authorized Official First Name:
MOHAMED
Authorized Official Middle Name:
Authorized Official Title or Position:
MD, OWNER
Authorized Official Telephone Number:
716-487-0911

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  193315 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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