Provider Demographics
NPI:1558354837
Name:SCHENK, GREGORY PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PETER
Last Name:SCHENK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:77 GOODELL STREET
Mailing Address - Street 2:STE. 240
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1243
Mailing Address - Country:US
Mailing Address - Phone:716-645-9694
Mailing Address - Fax:716-845-6699
Practice Address - Street 1:850 HOPKINS ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1729
Practice Address - Country:US
Practice Address - Phone:716-688-9641
Practice Address - Fax:716-688-9645
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00889749Medicaid
E37674Medicare UPIN
NY14238TMedicare ID - Type Unspecified