Provider Demographics
NPI:1235327834
Name:BUFFALO SUBURBAN I.D., INC.
Entity Type:Organization
Organization Name:BUFFALO SUBURBAN I.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEDARNATH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-447-6903
Mailing Address - Street 1:67 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4904
Mailing Address - Country:US
Mailing Address - Phone:716-649-0887
Mailing Address - Fax:716-646-4611
Practice Address - Street 1:2914 ELMWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1332
Practice Address - Country:US
Practice Address - Phone:716-447-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164017207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDG5745OtherRAILROAD MEDICARE
NY00027194102OtherUNIVERA
NY000528147003OtherBLUE CROSS
NY3412917OtherINDEPENDENT HEALTH
NYDG5745OtherRAILROAD MEDICARE