Provider Demographics
NPI:1073631644
Name:BRAIN & SPINE MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:BRAIN & SPINE MEDICAL SERVICES PLLC
Other - Org Name:DIA INVISION HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:LANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-631-3555
Mailing Address - Street 1:400 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5771
Mailing Address - Country:US
Mailing Address - Phone:716-631-3555
Mailing Address - Fax:716-631-9525
Practice Address - Street 1:400 INTERNATIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8243
Practice Address - Country:US
Practice Address - Phone:716-631-3555
Practice Address - Fax:716-631-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 133V00000X
NYX009257111N00000X
NY080912207RR0500X
NY201459207T00000X
NY239975207T00000X
NY113895207T00000X
NY2379102084N0400X
NY012275225100000X
NY027519225100000X
NY016278225100000X
NY008168363A00000X
NY009406363A00000X
NY007834363A00000X
NY010928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025085902OtherUNIVERA
NY00025085902OtherUNIVERA
NYAA1076Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER