1003807132 NPI number — PROSCAN RADIOLOGY BUFFALO, PLLC

Table of content: (NPI 1003807132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003807132 NPI number — PROSCAN RADIOLOGY BUFFALO, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSCAN RADIOLOGY BUFFALO, PLLC
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:
1003807132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5214 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-5373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-839-2600
Provider Business Mailing Address Fax Number:
716-839-6700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5214 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-5373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-839-2600
Provider Business Practice Location Address Fax Number:
716-839-6700
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
AMAYA
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SENIOR DIRECTOR, CORPORATE ADMIN
Authorized Official Telephone Number:
513-924-5174

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DB9023 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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