Provider Demographics
NPI:1508871930
Name:RAY, JENNIFER K (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3040 AMSDELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5835
Mailing Address - Country:US
Mailing Address - Phone:716-649-9000
Mailing Address - Fax:716-649-9005
Practice Address - Street 1:3050 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4658
Practice Address - Country:US
Practice Address - Phone:716-558-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2317842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070119000041OtherFIDELIS CARE OF NEW YORK
NY00027256203OtherUNIVERA HEALTHCARE
NYP00379449OtherRR MEDICARE
NY1609206OtherINDEPENDENT HEALTH
NY000528428003OtherBCBS
NY209606FFOtherPREFERRED CARE
NY02686377Medicaid
NY02686377Medicaid
NY209606FFOtherPREFERRED CARE
NYRB2372Medicare PIN
I45011Medicare UPIN