Basic Information
| Provider Information | |||||||||
| NPI: | 1396787891 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASCULAR & ENDOVASCULAR CENTER OF WNY, LLP | ||||||||
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| OtherOrganizationName: | ANAIN & ANAIN LLP | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 MAIN ST | ||||||||
| Address2: | SUITE 316 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142142693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166923302 | ||||||||
| FaxNumber: | 7166924342 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 MAIN ST | ||||||||
| Address2: | SUITE 316 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142142693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168372400 | ||||||||
| FaxNumber: | 7168373860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | ANAIN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7168372400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 02065947 | 05 | NY | MEDICAID |