Provider Demographics
NPI:1922038454
Name:JENSEN, ERIK J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:J
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:338 HARRIS HILL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7470
Mailing Address - Country:US
Mailing Address - Phone:716-634-4798
Mailing Address - Fax:716-634-0987
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3549
Practice Address - Fax:716-898-5262
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY219763-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155448Medicaid
NYH40313Medicare UPIN
NY02155448Medicaid