Healthcare Provider Details

I. General information

NPI: 1578940813
Provider Name (Legal Business Name): AJAY JURANGAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date: 12/14/2015
Reactivation Date: 10/31/2019

III. Provider practice location address

3095 HARLEM RD
CHEEKTOWAGA NY
14225-2500
US

IV. Provider business mailing address

3095 HARLEM RD
CHEEKTOWAGA NY
14225-2500
US

V. Phone/Fax

Practice location:
  • Phone: 716-228-8652
  • Fax: 716-893-3491
Mailing address:
  • Phone: 716-228-8652
  • Fax: 716-893-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD459762
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number300892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: