Provider Demographics
NPI:1902885601
Name:VISCO, JEFFREY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:VISCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5782
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:4955 N BAILEY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-857-8751
Practice Address - Fax:716-961-2225
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY229881-1208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026906501OtherUNIVERA
NY161000580OtherEMPIRE PLAN
NY161000580OtherNORTH AMERICAN PREFERRED
NY1412674OtherIHA
NY2588374Medicaid
NY000527799001OtherHEALTH NOW
NY000527799001OtherHEALTH NOW
NY161000580OtherEMPIRE PLAN