Provider Demographics
NPI:1972603033
Name:BUFFALO NIAGARA PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:BUFFALO NIAGARA PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-297-7040
Mailing Address - Street 1:6932 WILLIAMS RD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3071
Mailing Address - Country:US
Mailing Address - Phone:716-297-7040
Mailing Address - Fax:716-297-7048
Practice Address - Street 1:6932 WILLIAMS RD
Practice Address - Street 2:SUITE 1700
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3071
Practice Address - Country:US
Practice Address - Phone:716-297-7040
Practice Address - Fax:716-297-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00755784Medicaid
NYB35562Medicare UPIN
NY00755784Medicaid