Provider Demographics
NPI:1396704417
Name:UNIVERSITY UROLOGY INC
Entity type:Organization
Organization Name:UNIVERSITY UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRANIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-898-5008
Mailing Address - Street 1:100 HIGH ST
Mailing Address - Street 2:SUITE B201
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:716-859-2212
Mailing Address - Fax:716-859-1880
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:SUITE 119
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-898-5008
Practice Address - Fax:716-898-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207138Medicaid
NYAA0860Medicare ID - Type Unspecified