Basic Information
Provider Information
NPI: 1629462197
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUNTZ
FirstName: JOSEPH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 425 ESSJAY RD STE 170
Address2:  
City: WILLIAMSVILLE
State: NY
PostalCode: 142218235
CountryCode: US
TelephoneNumber: 7166301219
FaxNumber: 7168171726
Practice Location
Address1: 85 HIGH ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142031149
CountryCode: US
TelephoneNumber: 7166301000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/23/2015
LastUpdateDate: 12/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
208M00000X295275NYY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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