Provider Demographics
NPI:1023404845
Name:UNIVERSITY AT BUFFALO NEUROSURGERY, INC.
Entity type:Organization
Organization Name:UNIVERSITY AT BUFFALO NEUROSURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COURNYEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-218-1000
Mailing Address - Street 1:180 PARK CLUB LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5263
Mailing Address - Country:US
Mailing Address - Phone:716-839-9402
Mailing Address - Fax:
Practice Address - Street 1:180 PARK CLUB LN
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-5263
Practice Address - Country:US
Practice Address - Phone:716-839-9402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02301348Medicaid