Individual
MARY JANE PETRUZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
219 BRYANT ST, BUFFALO, NY 14222-2006
(716) 878-7349
(716) 888-3801
Mailing address
4511 HARLEM RD, SUITE 202, AMHERST, NY 14226-3803
(716) 839-6720
(716) 839-6740
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
179829
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010137401
UNIVERA
—
01
—
000524343001
BC/BS
—
01
—
0015503720001
PA MEDICAID
—
05
—
01169979
—
NY
01
—
040426001061
FIDELIS
—
01
—
1206399
IHA
—
Enumeration date
10/21/2006
Last updated
09/30/2008
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