Provider Demographics
NPI:1306844550
Name:NISWANDER, PHILIP R (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:NISWANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5339
Mailing Address - Country:US
Mailing Address - Phone:716-634-4441
Mailing Address - Fax:716-634-3174
Practice Address - Street 1:40 N UNION RD
Practice Address - Street 2:NISWANDER EYE CENTER
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5339
Practice Address - Country:US
Practice Address - Phone:716-634-4441
Practice Address - Fax:716-634-3174
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-07-22
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NY142714207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00766289Medicaid
NY11607CMedicare PIN
NYB35566Medicare UPIN
NY0346410001Medicare NSC