Basic Information
| Provider Information | |||||||||
| NPI: | 1952628315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 HIGH STREET | ||||||||
| Address2: | SUITE B4 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142091126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162181000 | ||||||||
| FaxNumber: | 7168597480 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HIGH STREET | ||||||||
| Address2: | SUITE B4 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142091126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162181000 | ||||||||
| FaxNumber: | 7168597480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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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 | 207T00000X | 259815 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3316263 | 05 | NY | MEDICAID | 000532992001 | 01 | NY | BC OF WNY | OTHER | 0616567 | 01 | NY | IHA | OTHER |