Healthcare Provider Details

I. General information

NPI: 1174506836
Provider Name (Legal Business Name): RICHARD J CORBELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2005
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ESSJAY RD BUFFALO MEDICAL GROUP, PC
WILLIAMSVILLE NY
14221-8216
US

IV. Provider business mailing address

6255 SHERIDAN DR SUITE 108 - CREDENTIALING DEPT
WILLIAMSVILLE NY
14221-4836
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1146
  • Fax: 716-817-1742
Mailing address:
  • Phone: 716-630-1219
  • Fax: 716-817-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number154527
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number154527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: