| Doctor Name: | TIFFANY L MOCK |
| NPI Number: | 1073936977 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RPA-C |
| License Number: | 017337 |
| Business Practice Address: | 2890 Niagara Falls Blvd North Tonawanda, NY - 141201114 |
| Business Phone Number: | 7168077337 |
| Business Fax Number: | 7168070848 |
| Mailing Address: | 2890 Niagara Falls Blvd, NORTH TONAWANDA |
| State: | NY |
| Postal Code: | 141201114 |
| Phone Number: | 7168077337 |
| Fax Number: | 7168070848 |
| NPI Enumeration Date: | 01/28/2014 |
| NPI Last Update Date: | 12/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 017337 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |