Provider Demographics
NPI:1710299201
Name:NIAGARA NEUROLOGICAL SERVICES AND SLEEP MEDICINE PLLC
Entity Type:Organization
Organization Name:NIAGARA NEUROLOGICAL SERVICES AND SLEEP MEDICINE PLLC
Other - Org Name:NIAGARA NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLIWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-575-0075
Mailing Address - Street 1:5320 MILITARY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-575-0075
Mailing Address - Fax:716-242-0611
Practice Address - Street 1:5320 MILITARY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-575-0075
Practice Address - Fax:716-242-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty