Basic Information
| Provider Information | |||||||||
| NPI: | 1003969759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MSUKU | ||||||||
| FirstName: | CROMWELL | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1526 WALDEN AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168957167 | ||||||||
| FaxNumber: | 7163324488 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142121845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168930062 | ||||||||
| FaxNumber: | 7168930070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.