1033706361 NPI number — MS. MARSHA LATRICE TABB ADVANCED CASAC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033706361 NPI number — MS. MARSHA LATRICE TABB ADVANCED CASAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TABB
Provider First Name:
MARSHA
Provider Middle Name:
LATRICE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ADVANCED CASAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEST
Provider Other First Name:
MARSHA
Provider Other Middle Name:
LATRICE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033706361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 LONGMEADOW RD APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-2974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-578-8685
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 NIAGARA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14201-1886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-853-1335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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