Provider Demographics
NPI:1235155581
Name:UNIVERSITY AT BUFFALO PATHOLOGISTS, INC
Entity Type:Organization
Organization Name:UNIVERSITY AT BUFFALO PATHOLOGISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:REID
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:HEFFNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:716-626-7927
Mailing Address - Street 1:3435 MAIN ST
Mailing Address - Street 2:240 FARBER HALL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-626-7927
Mailing Address - Fax:
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:240 FARBER HALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-626-7927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100000330Medicare PIN