Provider Demographics
NPI:1508802620
Name:KANALEY, JUSTIN C (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:KANALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3960 EAST ROBINSON ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2041
Mailing Address - Country:US
Mailing Address - Phone:716-691-3400
Mailing Address - Fax:716-691-3404
Practice Address - Street 1:3950 E ROBINSON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2041
Practice Address - Country:US
Practice Address - Phone:716-691-3400
Practice Address - Fax:716-691-3404
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY239741208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00027607702OtherUNIVERA
000528574003OtherBC/BS
NY02776272Medicaid
1213232OtherIHA
071206000057OtherFIDELIS
RB6094Medicare PIN