Provider Demographics
NPI:1841278496
Name:BUFFALO NEUROSURGERY PC
Entity type:Organization
Organization Name:BUFFALO NEUROSURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:EGNATCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-677-5005
Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:STE A105
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-677-6000
Mailing Address - Fax:716-677-6006
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:STE A105
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-677-6000
Practice Address - Fax:716-677-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01753539Medicaid
NY01753539Medicaid