Provider Demographics
NPI:1649202342
Name:KASNICKI, LAURIE (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KASNICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ABBOTT RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1700
Mailing Address - Country:US
Mailing Address - Phone:716-995-8801
Mailing Address - Fax:716-995-8810
Practice Address - Street 1:515 ABBOTT RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1700
Practice Address - Country:US
Practice Address - Phone:716-995-8801
Practice Address - Fax:716-995-8810
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020751503OtherUNIVERA
NY000528274002OtherBLUE CROSS
NY1213020OtherINDEPENDENT HEALTH
NY00020751503OtherUNIVERA HEALTHCARE
NY000528274003OtherBLUE CROSS WNY
NY01052120Medicaid