Provider Demographics
NPI:1194808535
Name:SADLER, LAURIE SULTZ (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:SULTZ
Last Name:SADLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0040
Mailing Address - Fax:716-323-0292
Practice Address - Street 1:1001 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0040
Practice Address - Fax:716-323-0292
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177952208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01163648Medicaid
000510827001OtherBC/BS
040426000752OtherFIDELIS
00010154001OtherUNIVERA
1205780OtherIHA
PA0014383090001Medicaid
BB1456Medicare ID - Type Unspecified
040426000752OtherFIDELIS
BB1456Medicare PIN