Provider Demographics
NPI:1932392412
Name:BUFFALO SPINE SURGERY, PLLC
Entity Type:Organization
Organization Name:BUFFALO SPINE SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPUCCINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-438-2973
Mailing Address - Street 1:46 DAVISON CT
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5370
Mailing Address - Country:US
Mailing Address - Phone:716-438-2973
Mailing Address - Fax:716-438-9267
Practice Address - Street 1:46 DAVISON CT
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5370
Practice Address - Country:US
Practice Address - Phone:716-438-2973
Practice Address - Fax:716-438-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196141-1207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005233405OtherBLUE CROSS OF WNY