Provider Demographics
NPI:1447224407
Name:PLESKOW, SANFORD RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:RONALD
Last Name:PLESKOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 INTERNATIONAL DR.
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5760
Mailing Address - Country:US
Mailing Address - Phone:716-631-3555
Mailing Address - Fax:716-631-9525
Practice Address - Street 1:400 INTERNATIONAL DR.
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-631-3555
Practice Address - Fax:716-631-9525
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010290501OtherEXCELLUS
NY0400964OtherINDEPENDENT HEALTH
NY1300912OtherGHI
NY4266681OtherAETNA
NYJ400016460OtherMEDICARE PTAN
NY0400964OtherINDEPENDENT HEALTH
NYJ400016460Medicare UPIN
NYSP072521Medicare ID - Type Unspecified