Provider Demographics
NPI:1952628315
Name:SNYDER, KENNETH VINCENT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:VINCENT
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:100 HIGH STREET
Mailing Address - Street 2:SUITE B4
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1126
Mailing Address - Country:US
Mailing Address - Phone:716-218-1000
Mailing Address - Fax:716-859-7480
Practice Address - Street 1:100 HIGH STREET
Practice Address - Street 2:SUITE B4
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1126
Practice Address - Country:US
Practice Address - Phone:716-218-1000
Practice Address - Fax:716-859-7480
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2016-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY259815207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3316263Medicaid
NY000532992001OtherBC OF WNY
NY0616567OtherIHA
NY0616567OtherIHA