Basic Information
Provider Information
NPI: 1164675898
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YONIS
FirstName: MAHFUZ
MiddleName: OUMER
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 908 NIAGARA FALLS BLVD STE 208
Address2:  
City: NORTH TONAWANDA
State: NY
PostalCode: 141202019
CountryCode: US
TelephoneNumber: 7166923302
FaxNumber: 7166924342
Practice Location
Address1: 462 GRIDER ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142153021
CountryCode: US
TelephoneNumber: 7168984801
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/26/2008
LastUpdateDate: 11/07/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X296661NYN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RN0300X296661NYY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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