Healthcare Provider Details

I. General information

NPI: 1659414605
Provider Name (Legal Business Name): BUFFALO THORACIC SURGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GATES CIRCLE BUFFALO THORACIC SURGICAL ASSOCIATES PC
BUFFALO NY
14209
US

IV. Provider business mailing address

3 GATES CIRCLE BUFFALO THORACIC SURGICAL ASSOCIATES PC
BUFFALO NY
14209
US

V. Phone/Fax

Practice location:
  • Phone: 716-885-0602
  • Fax: 716-885-0407
Mailing address:
  • Phone: 716-885-0602
  • Fax: 716-885-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: LUJEAN JENNINGS
Title or Position: PERSIDENT
Credential: MD
Phone: 716-885-0602