1255352241 NPI number — WARREN PAIN CLINIC AND ACUPUNCTURE CENTER, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255352241 NPI number — WARREN PAIN CLINIC AND ACUPUNCTURE CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN PAIN CLINIC AND ACUPUNCTURE CENTER, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255352241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 NIAGARA FALLS BLVD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
NORTH TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14120-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-692-2160
Provider Business Mailing Address Fax Number:
716-213-0935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 WEST ST. CLAIR STREET
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-2188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-726-7365
Provider Business Practice Location Address Fax Number:
814-726-7369
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOURTU
Authorized Official First Name:
MOHAMED
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
814-726-7365

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  MD049485L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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