1699842781 NPI number — DR. JERALD ROBERT SULTZ M.D.

Table of content: DR. JERALD ROBERT SULTZ M.D. (NPI 1699842781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699842781 NPI number — DR. JERALD ROBERT SULTZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULTZ
Provider First Name:
JERALD
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699842781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 N FOREST RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-3277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-634-1970
Provider Business Mailing Address Fax Number:
716-634-3845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 N FOREST RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-3277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-634-1970
Provider Business Practice Location Address Fax Number:
716-634-3845
Provider Enumeration Date:
11/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  181975 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CPS181975-4B . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 16-1605603 . This is a "TAX IDENTIFER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1309949 . This is a "INDEPEDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1320353 . This is a "UNITED EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000524867 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010309402 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000524867002 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50599 . This is a "CHOICE CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".