Individual
TIMOTHY DEZASTRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 GENESEE ST, BUFFALO, NY 14203
(716) 855-2866
(716) 855-2860
Mailing address
PO BOX 8000, DEPT 836, BUFFALO, NY 14267
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1781211
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000525009016
BLUE SHIELD OF WESTERN NY
—
01
—
000525009022
BLUE SHIELD OF WESTERN NY
—
01
—
000525009025
BLUE SHIELD OF WESTERN NY
—
05
—
01607547
—
NY
01
—
145797FF
PREFERRED CARE
—
01
—
300138602
RAILROAD MEDICARE
—
01
—
5609880
INDEPENDENT HEALTH
—
01
—
CRDRA178121
WORKERS COMPENSATION
NY
01
—
P00003640
RAILROAD MEDICARE
—
01
—
RB6952
MEDICARE
—
Enumeration date
05/03/2006
Last updated
05/13/2008
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