Provider Demographics
NPI:1194768796
Name:JANICKE, DAVID M (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:JANICKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:305 CAYUGA RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1980
Mailing Address - Country:US
Mailing Address - Phone:716-691-8838
Mailing Address - Fax:716-564-1134
Practice Address - Street 1:1540 MAPLE RD
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3647
Practice Address - Country:US
Practice Address - Phone:716-691-8838
Practice Address - Fax:716-564-1134
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-08-26
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Provider Licenses
StateLicense IDTaxonomies
NY181544207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000511303006OtherBLUE CROSS BLUE SHIELD
NY01290362Medicaid
NY040426000261OtherFIDELIS
NY110124030OtherRAILROAD MEDICARE
NY00020039602OtherUNIVERA
NY3991179OtherINDEPENDENT HEALTH
NY00020039602OtherUNIVERA
NY110124030OtherRAILROAD MEDICARE