Basic Information
| Provider Information | |||||||||
| NPI: | 1972768042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GURSKE-DEPERIO | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 GENESEE ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142251994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169065908 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5959 BIG TREE RD | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141272291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168214400 | ||||||||
| FaxNumber: | 7168292138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2008 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 251338 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | ME106411 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 251338 | 01 | NY | LICENSE NUMBER, STATE OF NEW YORK | OTHER | 390200000X | 01 | NY | STUDENT, HEALTH CARE | OTHER |