Organization
ACADEMIC BUFFALONIAS IN PHYSICAL MEDICINE & REHABILITATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY G WANG M.D. (PRESIDENT)
(716) 832-1000
Entity
Organization
Contact information
Practice address
2121 MAIN ST, SUITE 112, BUFFALO, NY 14214-2693
(716) 832-1000
(716) 832-1001
Mailing address
2121 MAIN ST, SUITE 210 SETON BLDG., BUFFALO, NY 14214-2693
(716) 832-1000
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
216631
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J100050852
MEDICARE PTAN
NY
Enumeration date
03/17/2011
Last updated
10/04/2013
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