Provider Demographics
NPI:1699842781
Name:SULTZ, JERALD ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:ROBERT
Last Name:SULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1301 N FOREST RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3277
Mailing Address - Country:US
Mailing Address - Phone:716-634-1970
Mailing Address - Fax:716-634-3845
Practice Address - Street 1:1301 N FOREST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3277
Practice Address - Country:US
Practice Address - Phone:716-634-1970
Practice Address - Fax:716-634-3845
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY181975208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCPS181975-4BOtherWORKER'S COMPENSATION
NY16-1605603OtherTAX IDENTIFER
NY1309949OtherINDEPEDENT HEALTH
NY1320353OtherUNITED EMPIRE
NY000524867OtherBLUE CROSS BLUE SHIELD
NY00010309402OtherUNIVERA
NY000524867002OtherCOMMUNITY BLUE
NY50599OtherCHOICE CARE
NY000524867OtherBLUE CROSS BLUE SHIELD
NY000524867002OtherCOMMUNITY BLUE
NY14394BMedicare PIN