Provider Demographics
NPI:1942541933
Name:UNIVERSITY AT BUFFALO OTOLARYNGOLOGY, INC
Entity Type:Organization
Organization Name:UNIVERSITY AT BUFFALO OTOLARYNGOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZZUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-632-2000
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-332-3525
Practice Address - Street 1:8207 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6060
Practice Address - Country:US
Practice Address - Phone:716-632-2000
Practice Address - Fax:716-632-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051172207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty