1639213721 NPI number — DANIEL A. BUSCAGLIA, D.O., P.C.

Table of content: (NPI 1639213721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639213721 NPI number — DANIEL A. BUSCAGLIA, D.O., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL A. BUSCAGLIA, D.O., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1639213721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 MAIN ST
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-839-5851
Provider Business Mailing Address Fax Number:
716-839-5841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 MAIN ST
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-839-5851
Provider Business Practice Location Address Fax Number:
716-839-5841
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUSCAGLIA
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
MEDICAL DIRECTOR AND PRESIDENT
Authorized Official Telephone Number:
716-839-5851

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  193737-1 , 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: 00010379901 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0007672065 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0192337 . This is a "INDEPENDENT HEALTH CORP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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