Provider Demographics
NPI:1609136126
Name:NILES, PHILIP ISAAC (MD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ISAAC
Last Name:NILES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6480 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5852
Mailing Address - Country:US
Mailing Address - Phone:716-631-3300
Mailing Address - Fax:716-631-3303
Practice Address - Street 1:6480 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5852
Practice Address - Country:US
Practice Address - Phone:716-631-3300
Practice Address - Fax:716-631-3303
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2020-04-17
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Provider Licenses
StateLicense IDTaxonomies
NY2861401207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist