Provider Demographics
NPI:1710265640
Name:JP BUFFALINO MEDICAL P.C.
Entity Type:Organization
Organization Name:JP BUFFALINO MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUFFALINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-504-4040
Mailing Address - Street 1:444 LAKEVILLE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:444 LAKEVILLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1165
Practice Address - Country:US
Practice Address - Phone:516-504-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120916-1208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty