Individual
DR. NATHANIEL MARK IVANICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ELM AND CARLTON STREETS, BUFFALO, NY 14263-0001
(716) 845-2300
Mailing address
ELM AND CARLTON STREETS, BUFFALO, NY 14263-0001
(716) 845-2300
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
298396
NY
207RP1001X
Pulmonary Disease Physician
C154270
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
298396
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05711793
—
NY
01
—
298396
NYS LICENSE
NY
Enumeration date
05/24/2007
Last updated
09/21/2021
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