Provider Demographics
NPI:1649232497
Name:SANSANO, MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SANSANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:515 ABBOTT RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1700
Mailing Address - Country:US
Mailing Address - Phone:716-828-3460
Mailing Address - Fax:716-828-3465
Practice Address - Street 1:515 ABBOTT RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1700
Practice Address - Country:US
Practice Address - Phone:716-828-3460
Practice Address - Fax:716-828-3465
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY168353207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01139899Medicaid
NYE16871Medicare UPIN
NY01139899Medicaid