Provider Demographics
NPI:1447320593
Name:UNIVERSITY AT BUFFALO OTOLARYNGOLOGY, INC.
Entity type:Organization
Organization Name:UNIVERSITY AT BUFFALO OTOLARYNGOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-689-1901
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT. 086
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-689-1901
Mailing Address - Fax:
Practice Address - Street 1:1237 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1435
Practice Address - Country:US
Practice Address - Phone:716-689-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0050Medicare ID - Type UnspecifiedGROUP