Healthcare Provider Details

I. General information

NPI: 1225271364
Provider Name (Legal Business Name): BUFFALO ADVANCED MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 04/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 ELMWOOD AVE
BUFFALO NY
14222-1802
US

IV. Provider business mailing address

56 GRAND VIEW TRL
ORCHARD PARK NY
14127-3756
US

V. Phone/Fax

Practice location:
  • Phone: 716-984-7840
  • Fax:
Mailing address:
  • Phone: 716-984-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number249117-1
License Number StateNY

VIII. Authorized Official

Name: DR. EDWARD TRUDEAU PLATA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 716-984-7840