Provider Demographics
NPI:1033419213
Name:BUFFALO CENTRE FOR THE TREATMENT OF EATING DISORDERS
Entity Type:Organization
Organization Name:BUFFALO CENTRE FOR THE TREATMENT OF EATING DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:315-422-0300
Mailing Address - Street 1:95 JOHN MUIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228
Mailing Address - Country:US
Mailing Address - Phone:716-276-6939
Mailing Address - Fax:315-479-8455
Practice Address - Street 1:600 E GENESEE ST
Practice Address - Street 2:SUITE 217
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2100
Practice Address - Country:US
Practice Address - Phone:315-422-0300
Practice Address - Fax:315-479-8455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRE SYRACUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty