Provider Demographics
NPI:1992788657
Name:RIEGEL, BRIAN JAMES (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:RIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:705 MAPLE RD STE 300
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3291
Practice Address - Country:US
Practice Address - Phone:716-710-8266
Practice Address - Fax:716-710-8266
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218502207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB6956OtherMEDICARE
NY000527333001OtherBLUE CROSS COMMUNITY BLUE
NY00026413301OtherUNIVERAL
NY02430486Medicaid
NY2111669OtherINDEP HEALTH
00026413303OtherUNIVERA
NYRB2614Medicare PIN
NY02430486Medicaid
H94629Medicare UPIN