Healthcare Provider Details

I. General information

NPI: 1902587231
Provider Name (Legal Business Name): MICHAEL BUZIAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2283 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-1819
US

IV. Provider business mailing address

2283 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-1819
US

V. Phone/Fax

Practice location:
  • Phone: 716-773-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number013741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: