Organization
PHOENIX RISING MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAJUDDIN M JIVA MD (OWNER)
(716) 334-9879
Entity
Organization
Contact information
Practice address
2829 WEHRLE DR STE 11A, WILLIAMSVILLE, NY 14221-7387
(716) 458-0069
(716) 458-0061
Mailing address
2829 WEHRLE DR STE 11A, WILLIAMSVILLE, NY 14221-7387
(716) 458-0069
(716) 458-0061
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
183042
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01447790
—
NY
Enumeration date
07/18/2007
Last updated
02/06/2025
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