Healthcare Provider Details

I. General information

NPI: 1871038901
Provider Name (Legal Business Name): LANDMARK PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 BIDWELL PKWY
BUFFALO NY
14222-1164
US

IV. Provider business mailing address

142 BIDWELL PKWY
BUFFALO NY
14222-1164
US

V. Phone/Fax

Practice location:
  • Phone: 716-462-8871
  • Fax:
Mailing address:
  • Phone: 716-462-8871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number264173
License Number StateNY

VIII. Authorized Official

Name: JAROD MASCI
Title or Position: OWNER
Credential: M.D.
Phone: 716-462-8871