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NPI Code Detail

MEDICARE: NICHOLAS PETER BOSSERT

MEDICARE: NICHOLAS PETER BOSSERT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant023593NY
2363AM0700XMedical Physician Assistant023593NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538711767
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS PETER BOSSERT
Provider Business Mailing Address
First Line : 6255 SHERIDAN DR STE 200
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8096
Country : US
Telephone Number : 716-636-7979
Fax Number : 716-929-0192
Provider Business Practice Location Address
First Line : 6255 SHERIDAN DR STE 200
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8096
Country : US
Telephone Number : 716-636-7979
Fax Number : 716-929-0192
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2019
Last Update Date : 04/14/2026

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Directions to “ NICHOLAS PETER BOSSERT ” Practice Location

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