Provider Demographics
NPI:1942247358
Name:PROFESSIONAL EMERGENCY SERVICES PLLC
Entity type:Organization
Organization Name:PROFESSIONAL EMERGENCY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:PUNDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-580-1801
Mailing Address - Street 1:6 FOUNTAIN PLZ
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2211
Mailing Address - Country:US
Mailing Address - Phone:716-691-8838
Mailing Address - Fax:716-564-1134
Practice Address - Street 1:6 FOUNTAIN PLZ
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2211
Practice Address - Country:US
Practice Address - Phone:716-691-8838
Practice Address - Fax:716-564-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000005133161OtherBLUE CROSS BLUE SHIELD
NY000005133161OtherBLUE CROSS BLUE SHIELD
NY=========OtherINDEPENDENT HEALTH