Individual
JILL TIRABASSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD MPH
Contact information
Practice address
462 GRIDER ST, BUFFALO, NY 14215-3021
(716) 831-8612
Mailing address
462 GRIDER ST, BUFFALO, NY 14215-3021
(716) 831-8612
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
268251
MA
207QS0010X
Sports Medicine (Family Medicine) Physician
268251
MA
2083P0901X
Public Health & General Preventive Medicine Physician
302979
NY
Other
Enumeration date
04/18/2012
Last updated
08/02/2022
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