1568483485 NPI number — BUFFALO RESPIRATORY THERAPY, LLC

Table of content: MS. KIM GRONDIN LMT (NPI 1154041317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568483485 NPI number — BUFFALO RESPIRATORY THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUFFALO RESPIRATORY THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568483485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 LIMESTONE DR
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-8600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-677-9277
Provider Business Mailing Address Fax Number:
716-677-9270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 LIMESTONE DR
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-677-9277
Provider Business Practice Location Address Fax Number:
716-677-9270
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLITO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
716-677-9277

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02849296 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021213300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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