Physician Compare National (NPI:1699842781)

HEALTHCARE PROVIDER: JERALD ROBERT SULTZ M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1699842781
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466520713
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081014000291
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SULTZ
	Individual professional last name
Provider First Name	JERALD
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NY UPSTATE MEDICAL UNIVERSITY
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1301 N FOREST RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	WILLIAMSVILLE
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	142213277
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7166341970
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330102
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KENMORE MERCY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y