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Individual

DR. VIVIAN KUDGUS FASULA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
70 PROFESSIONAL PARKWAY, LOCKPORT, NY 14094-5366
(716) 434-7505
Mailing address
1254 CHARLESGATE CIRCLE, EAST AMHERST, NY 14051-1216
(716) 636-0113

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
148889
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00824488
NY
01
16-1383123
FEDERAL ID
01
DISABILITY
D30278
NY
Enumeration date
04/28/2006
Last updated
05/14/2009
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