=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740330851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUFFALO NIAGARA MEDICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 941 WASHINGTON ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14203-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-882-1212
-----------------------------------------------------
Fax | 716-882-1579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 941 WASHINGTON ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14203-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-882-1212
-----------------------------------------------------
Fax | 716-882-1579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. JESSLYN PERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-882-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------