Provider Demographics
NPI:1609813583
Name:AMBULATORY MEDICAL ANESTHESIA SERVICE, PC
Entity Type:Organization
Organization Name:AMBULATORY MEDICAL ANESTHESIA SERVICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:BURDICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-650-9760
Mailing Address - Street 1:PO BOX 3478
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3478
Mailing Address - Country:US
Mailing Address - Phone:716-650-9760
Mailing Address - Fax:716-650-9622
Practice Address - Street 1:945 SWEET HOME RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-831-9435
Practice Address - Fax:716-650-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052106Medicaid
NYAA0632Medicare ID - Type Unspecified