Healthcare Provider Details

I. General information

NPI: 1407119266
Provider Name (Legal Business Name): MATTHEW JAMES BRUEHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST FL 4
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-0110
  • Fax: 716-323-0296
Mailing address:
  • Phone: 716-323-0225
  • Fax: 716-323-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35.152967
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2015-00802
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD488449
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number336628
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: