Organization Active NPI

Academic Buffalonias in Physical Medicine & Rehabilitation PC

  • Physical Medicine & Rehabilitation Physician
  • Buffalo, NY
National Provider Identifier
1063711992
Registry record updated Oct 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
216631 Issued in NY
Legal business name
ACADEMIC BUFFALONIAS IN PHYSICAL MEDICINE & REHABILITATION PC
Practice address
2121 Main St
Suite 112
Buffalo, NY 14214-2693
Phone
(716) 832-1000
Fax
(716) 832-1001
NPI assigned
Mar 17, 2011
Last updated
Oct 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary G Wang, M.D.NPI 1053382051
Title
President
Phone
(716) 832-1000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 216631 NY Primary

Addresses

Primary practice location

2121 Main St
Suite 112
Buffalo, NY 14214-2693

Mailing address

2121 Main St
Suite 210 Seton BLDG.
Buffalo, NY 14214-2693
Phone (716) 832-1000

Other identifiers 1

IdentifierTypeStateIssuer
J100050852OtherNYMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110727000422 NY Part B Supplier - Clinic/Group Practice 8123296654 Receives reassigned benefits from 1 practitioner
Practice locations: Buffalo, NY

National Provider Directory

National Provider Directory

Locations

2121 Main St
Ste 210
Buffalo, NY 14214
Phone (716) 832-1000

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380844800000",
    "number": "1063711992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 MAIN ST",
            "address_2": "SUITE 210 SETON BLDG.",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142142693",
            "telephone_number": "716-832-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 MAIN ST",
            "address_2": "SUITE 112",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142142693",
            "telephone_number": "716-832-1000",
            "fax_number": "716-832-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC BUFFALONIAS IN PHYSICAL MEDICINE & REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2013-10-04",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-832-1000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "216631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "J100050852",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.