Provider Demographics
NPI:1699864686
Name:TRUSKINOVSKY, ALEXANDER M (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:M
Last Name:TRUSKINOVSKY
Suffix:
Gender:M
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:ELM AND CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:716-845-2300
Mailing Address - Fax:716-845-3427
Practice Address - Street 1:ELM AND CARLTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:716-845-3427
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273884207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0079322Medicaid
MN11-00014OtherMEDICA PRIMARY
MN11-00412OtherMEDICA CHOICE
MNB514OtherCHAMPUS
MNHP57488OtherHEALTH PARTNERS
WI34560700Medicaid
MN2230946OtherARAZ
MN608R8TROtherBCBS
IA0581165Medicaid
MN462493900Medicaid
MN1042014OtherPREFERRED ONE
MN132342OtherUCARE
MN11-00412OtherMEDICA CHOICE
MN220001029Medicare ID - Type Unspecified
WI34560700Medicaid