Healthcare Provider Details

I. General information

NPI: 1205468055
Provider Name (Legal Business Name): TRINITY MEDICAL WNY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 MAIN ST STE 316
BUFFALO NY
14214-2673
US

IV. Provider business mailing address

2121 MAIN ST STE 316
BUFFALO NY
14214-2673
US

V. Phone/Fax

Practice location:
  • Phone: 716-837-2400
  • Fax: 716-837-3860
Mailing address:
  • Phone: 716-837-2400
  • Fax: 716-837-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS CUMBO
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 716-837-2400