Provider Demographics
NPI:1508898305
Name:UNIVERSITY AT BUFFALO SURGEONS INC
Entity Type:Organization
Organization Name:UNIVERSITY AT BUFFALO SURGEONS INC
Other - Org Name:UNIVERSITY SURGICAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRIL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-898-3779
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT #313
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-898-5227
Mailing Address - Fax:716-898-5029
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DK MILLER BLDG
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5186
Practice Address - Fax:716-898-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02332410Medicaid
AA1324Medicare ID - Type Unspecified