Healthcare Provider Details

I. General information

NPI: 1023545654
Provider Name (Legal Business Name): JOSEPH SAMUEL MODICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GEORGE KARL BLVD
BUFFALO NY
14221-7183
US

IV. Provider business mailing address

3980 SHERIDAN DR
AMHERST NY
14226-1727
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-2000
  • Fax:
Mailing address:
  • Phone: 716-250-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number301104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: