TIMOTHY DEZASTRO (NPI# 1598723017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598723017 |
| Entity Type | Individual |
| Full Name | TIMOTHY DEZASTRO |
| Credential | MD |
| Practice Address |
222 Genesee St Buffalo NY 14203 |
| Mailing Address |
Po Box 8000 Dept 836 Buffalo NY 14267 |
| Practice Telephone | 7168552866 |
| Practice Fax Number | 7168552860 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2008-05-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
1781211 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE | RB6952 | 01 | |
| NY | 01607547 | 05 | |
| PREFERRED CARE | 145797FF | 01 | |
| NY | WORKERS COMPENSATION | CRDRA178121 | 01 |
| RAILROAD MEDICARE | P00003640 | 01 | |
| BLUE SHIELD OF WESTERN NY | 000525009025 | 01 | |
| BLUE SHIELD OF WESTERN NY | 000525009016 | 01 | |
| BLUE SHIELD OF WESTERN NY | 000525009022 | 01 | |
| INDEPENDENT HEALTH | 5609880 | 01 | |
| RAILROAD MEDICARE | 300138602 | 01 |
| Street Address |
222 GENESEE ST |
| City | BUFFALO |
| State | NY |
| Zip Code | 14203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285692657 | Frank J Mascaro | Radiology | 222 Genesee St, Buffalo, NY 14203 | 2006-05-03 |
| 1720392905 | David Engin | Radiology | 222 Genesee St, Buffalo, NY 14203-1512 | 2010-07-30 |
| 1982775243 | Wnymobile Radiology Professionals At Your Door LLP | Radiology | 222 Genesee St, Buffalo, NY 14203-1512 | 2006-11-10 |
| 1053356865 | Eastern Niagara Radiology & Nuclear Medicine Associates, PC | Radiology | 222 Genesee St, Buffalo, NY 14203-1512 | 2006-06-17 |
| 1043255854 | Western New York Mri, LLP | Radiology | 222 Genesee St, Buffalo, NY 14203-1512 | 2006-06-17 |
| 1871551234 | Joseph E Serghany | Radiology | 222 Genesee St, Buffalo, NY 14203 | 2006-05-03 |
| 1174581649 | Shahir Aiad | Radiology | 222 Genesee St, Buffalo, NY 14203 | 2006-05-03 |
| 1083672554 | Aurea S Desouza | Radiology | 222 Genesee St, Buffalo, NY 14203-1512 | 2006-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912514902 | Valerie Anne Conley | Counselor | 475 Elllicott St., Buffalo, NY 14203 | 2020-09-24 |
| 1457975674 | Qing Ma | Pharmacist | Nys Center of Excellence In Bioinformatics and Life Sci, 701 Ellicott Street, Buffalo, NY 14203 | 2020-06-03 |
| 1265056659 | Elizabeth Nicole Mancuso | Student in an Organized Health Care Education/Training Program | 1001 Main Street University At Buffalo, Department of P, 5th Floor, Buffalo, NY 14203 | 2020-06-02 |
| 1720601404 | Ronak Dhiraj Bahuva | Student in an Organized Health Care Education/Training Program | 955 Main Street, University At Buffalo, Jacobs School O, Buffalo, NY 14203 | 2020-05-28 |
| 1780207266 | Jaya Mishra | Student in an Organized Health Care Education/Training Program | 818 Ellicot Street, Buffalo, NY 14203 | 2020-05-19 |
| 1013530617 | Amanpreet Kaur Singh | Student in an Organized Health Care Education/Training Program | 77 Goodell Street Department of Medicine, Suite 240, Buffalo, NY 14203 | 2020-05-19 |
| 1013538917 | Leen Hosam Alyacoub | Student in an Organized Health Care Education/Training Program | 100 High Street, D2-76 Buffalo, Ny 14203, Buffalo Gener, Buffall, NY 14203 | 2020-05-01 |
| 1003436601 | Maxiam Dean | Student in an Organized Health Care Education/Training Program | Ub Family Residency Program, 77 Goodell Street, 2nd Floor, Buffalo, NY 14203 | 2020-04-23 |
| 1144849837 | Jennifer Anthone-kloss | Student in an Organized Health Care Education/Training Program | Anesthesiology Residency & Fellowship Programs, Ub Gateway, 77 Goodell Street, Suite 550, Buffalo, NY 14203 | 2020-04-13 |
| 1821658873 | Peter William Ip Fung Chun | Student in an Organized Health Care Education/Training Program | 1001 Main Street, Room 5145, Division of Pediatric Medical Education, Buffalo, NY 14203 | 2019-06-20 |
| Find all providers in zip 14203 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740403526 | Thomas Joseph Laudico | Radiology | Elm and Carlton Street, Buffalo, NY 14263-0001 | 2007-04-10 |
| 1346367935 | Andrew T Dunn | Radiology | 100 High St Fl 2, Buffalo, NY 14203-1126 | 2007-03-26 |
| 1508807769 | David A Paul | Radiology | 2828 Main St, Buffalo, NY 14214-1722 | 2006-06-09 |
| 1285692657 | Frank J Mascaro | Radiology | 222 Genesee St, Buffalo, NY 14203 | 2006-05-03 |
| 1053379412 | Robert E Lutnick | Radiology | 222 Genesee Street, Buffalo, NY 14203 | 2006-05-03 |
| 1568420149 | Wendy E Zimmer | Radiology | 32 Saint Catherines Ct, Buffalo, NY 14222-1614 | 2006-05-03 |
| 1477531598 | Charles Ray Gosnell | Radiology | 497 West Lott, Buffalo, WY 82834-1609 | 2006-01-09 |
| 1588667083 | Ahmed Nabil Belal | Radiology | Elm and Carlton Streets, Buffalo, NY 14263-0001 | 2005-05-27 |
| 1548785140 | Jennifer Lynn Shotwell | Radiology | 462 Grider St, Buffalo, NY 14215-3021 | 2017-08-04 |
| 1669823175 | David Weinthrop Levine | Radiology | 832 Walden Ave, Buffalo, NY 14211-2639 | 2016-06-27 |
| Find all providers in BUFFALO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.