Healthcare Provider Details

I. General information

NPI: 1104815679
Provider Name (Legal Business Name): JAY M BOLNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 ORCHARD PARK RD
WEST SENECA NY
14224-4658
US

IV. Provider business mailing address

3050 ORCHARD PARK RD
WEST SENECA NY
14224-4658
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-5222
  • Fax: 716-675-9329
Mailing address:
  • Phone: 716-766-5222
  • Fax: 716-675-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number237929
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD438097
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number237929-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: