Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 196898 | NY |
Y | 2080P0205X | Pediatric Endocrinologist | 196898 | NY |
NPI | 1144303579 |
---|---|
Provider Name | John Georgiou Buchlis |
First Address | Buffalo, NY 14203-1009 |
Second Address | Buffalo, NY 14203-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010306101 | UNIVERA (01) | |
000524880001 | BC/BS (01) | |
0016886330001 | (05) | PA |
01752170 | (05) | NY |
040426001452 | FIDELIS (01) | |
G52373 | (02) | |
IHA | 4509252 (01) |