Healthcare Provider Details

I. General information

NPI: 1003969759
Provider Name (Legal Business Name): CROMWELL PETER MSUKU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 BROADWAY ST
BUFFALO NY
14212-1845
US

IV. Provider business mailing address

1526 WALDEN AVE SUITE 400
CHEEKTOWAGA NY
14225-4965
US

V. Phone/Fax

Practice location:
  • Phone: 716-893-0062
  • Fax: 716-893-0070
Mailing address:
  • Phone: 716-895-7167
  • Fax: 716-332-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: