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General NPI Number Information
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NPI Number | 1871038901
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Entity Type | Organization
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Legal Business Name | LANDMARK PSYCHIATRY PC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 142 BIDWELL PKWY
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City | BUFFALO
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State | NY
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Zip | 14222-1164
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Country | US
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Telephone | 716-462-8871
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Fax |
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Provider Business Mailing Address
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Address Line | 142 BIDWELL PKWY
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City | BUFFALO
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State | NY
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Zip | 14222-1164
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Country | US
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Telephone | 716-462-8871
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAROD MASCI
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Credential | M.D.
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Telephone | 716-462-8871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 264173
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License Number State | NY
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