Provider Demographics
NPI:1144408063
Name:NIAGARA LABMASTERS
Entity Type:Organization
Organization Name:NIAGARA LABMASTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:KOMM
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:716-694-4388
Mailing Address - Street 1:2342 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-4759
Mailing Address - Country:US
Mailing Address - Phone:716-694-4388
Mailing Address - Fax:716-694-1140
Practice Address - Street 1:2342 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-4759
Practice Address - Country:US
Practice Address - Phone:716-694-4388
Practice Address - Fax:716-694-1140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIAGARA LABMASTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0509630002Medicare NSC