Healthcare Provider Details

I. General information

NPI: 1144284464
Provider Name (Legal Business Name): BUFFALO ORTHOPAEDIC GROUP,LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 PARK CLUB LANE SUITE 100
WILLIAMSVILLE NY
14221
US

IV. Provider business mailing address

192 PARK CLUB LANE SUITE 100
WILLIAMSVILLE NY
14221-5328
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-1101
  • Fax:
Mailing address:
  • Phone: 716-204-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number210531
License Number StateNY

VIII. Authorized Official

Name: GERALDINE TESTA
Title or Position: OFFICE MANAGER
Credential:
Phone: 716-204-1101