Provider Demographics
NPI:1124075908
Name:WNY INTERNAL MEDICINE P.C.
Entity type:Organization
Organization Name:WNY INTERNAL MEDICINE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHOUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:YASIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-690-2291
Mailing Address - Street 1:445 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6150
Mailing Address - Country:US
Mailing Address - Phone:716-690-2291
Mailing Address - Fax:716-690-2369
Practice Address - Street 1:445 TREMONT ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6150
Practice Address - Country:US
Practice Address - Phone:716-690-2291
Practice Address - Fax:716-690-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1543Medicare ID - Type Unspecified