Provider Demographics
NPI:1427520030
Name:BUFFALO NEUROMUSCULOSKELETAL MEDICINE PLLC
Entity type:Organization
Organization Name:BUFFALO NEUROMUSCULOSKELETAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CUKIERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:716-858-0264
Mailing Address - Street 1:8604 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7463
Mailing Address - Country:US
Mailing Address - Phone:716-858-0264
Mailing Address - Fax:877-522-3080
Practice Address - Street 1:8604 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7463
Practice Address - Country:US
Practice Address - Phone:716-858-0264
Practice Address - Fax:877-522-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04848606Medicaid