Healthcare Provider Details

I. General information

NPI: 1376462473
Provider Name (Legal Business Name): MARISAH JANUSZKIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 UNION RD
BUFFALO NY
14225-1851
US

IV. Provider business mailing address

94 N TRANSIT HILL DR
DEPEW NY
14043-4848
US

V. Phone/Fax

Practice location:
  • Phone: 716-505-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: