Provider Demographics
NPI:1033484894
Name:GREATER BUFFALO UNITED IPA
Entity Type:Organization
Organization Name:GREATER BUFFALO UNITED IPA
Other - Org Name:GREATER BUFFALO UNITED ACCOUNTABLE HEALTHCARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-882-0366
Mailing Address - Street 1:564 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1108
Mailing Address - Country:US
Mailing Address - Phone:716-882-0366
Mailing Address - Fax:716-830-4840
Practice Address - Street 1:564 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201
Practice Address - Country:US
Practice Address - Phone:716-882-0366
Practice Address - Fax:716-830-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185052207Q00000X
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty