Provider Demographics
NPI: | 1851739601 |
---|---|
Name: | VASCULAR INTERVENTIONAL SERVICES |
Entity Type: | Organization |
Organization Name: | VASCULAR INTERVENTIONAL SERVICES |
Other - Org Name: | BUFFALO VASCULAR CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | AZHER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | IQBAL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 716-859-1062 |
Mailing Address - Street 1: | 9 ORCHARD HILL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ORCHARD PARK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14127-3524 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 716-859-1062 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6335 TRANSIT RD |
Practice Address - Street 2: | |
Practice Address - City: | DEPEW |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14043-1030 |
Practice Address - Country: | US |
Practice Address - Phone: | 716-859-1062 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-06-13 |
Last Update Date: | 2013-06-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Single Specialty |