Provider Demographics
NPI:1851333892
Name:STANIEVICH, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:STANIEVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PARK CLUB LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5263
Mailing Address - Country:US
Mailing Address - Phone:716-634-7350
Mailing Address - Fax:
Practice Address - Street 1:180 PARK CLUB LN
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5263
Practice Address - Country:US
Practice Address - Phone:716-634-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143100207Y00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00607974Medicaid
NYP00145049OtherMEDICARE RAILROAD ID
NY000508067004OtherBCBS OF WNY ID
NY00052415002OtherUNIVERA ID
NY1000417OtherINDEPENDENT HEALTH ID
NYP00145049OtherMEDICARE RAILROAD ID
NY000508067004OtherBCBS OF WNY ID