Healthcare Provider Details

I. General information

NPI: 1568840411
Provider Name (Legal Business Name): VITALY BUZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT ROAD
BUFFALO NY
14220
US

IV. Provider business mailing address

508 9TH AVE APT 4FN
NEW YORK NY
10018-2824
US

V. Phone/Fax

Practice location:
  • Phone: 716-826-7000
  • Fax: 716-828-2700
Mailing address:
  • Phone: 716-341-4059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number33712
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: