Provider Demographics
NPI: | 1881659506 |
---|---|
Name: | BUFFALO MEDICAL GROUP, P.C. |
Entity Type: | Organization |
Organization Name: | BUFFALO MEDICAL GROUP, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DANIEL |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | SCULLY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CEO |
Authorized Official - Phone: | 716-630-2500 |
Mailing Address - Street 1: | 425 ESSJAY RD STE 170 |
Mailing Address - Street 2: | |
Mailing Address - City: | WILLIAMSVILLE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14221-8235 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 716-630-1219 |
Mailing Address - Fax: | 716-817-1726 |
Practice Address - Street 1: | 325 ESSJAY RD |
Practice Address - Street 2: | 4TH FLOOR ADMIN |
Practice Address - City: | WILLIAMSVILLE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14221-8243 |
Practice Address - Country: | US |
Practice Address - Phone: | 716-630-2500 |
Practice Address - Fax: | 716-630-2509 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-04-18 |
Last Update Date: | 2022-09-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207ND0900X, 207Q00000X, 207R00000X, 207U00000X, 207V00000X, 207W00000X, 207Y00000X, 2084P0800X, 2085B0100X, 208600000X, 208800000X, 208M00000X | ||
NY | 261QH0100X, 261QM1300X, 291U00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207ND0900X | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | Group - Multi-Specialty |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 02997799 | Medicaid | |
NY | J100000308 | Medicare PIN |