Provider Demographics
NPI:1144415167
Name:MAYA DEVI SRIVASTAVA MD PH DPC
Entity Type:Organization
Organization Name:MAYA DEVI SRIVASTAVA MD PH DPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-656-0078
Mailing Address - Street 1:1000 YOUNGS RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2644
Mailing Address - Country:US
Mailing Address - Phone:716-688-0525
Mailing Address - Fax:716-688-0569
Practice Address - Street 1:1000 YOUNGS RD STE 208
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2644
Practice Address - Country:US
Practice Address - Phone:716-688-0525
Practice Address - Fax:716-688-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202393207K00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0636Medicare PIN