Healthcare Provider Details

I. General information

NPI: 1831568831
Provider Name (Legal Business Name): LARISSA BUZAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2015
Last Update Date: 09/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 HARLEM RD SUITE 5
CHEEKTOWAGA NY
14225-1552
US

IV. Provider business mailing address

7276 WOODHAVEN DR
LOCKPORT NY
14094-6269
US

V. Phone/Fax

Practice location:
  • Phone: 716-833-9000
  • Fax:
Mailing address:
  • Phone: 716-998-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number647980-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: