Provider Demographics
NPI:1255498275
Name:EPILEPSY ASSOCIATION OF WNY INC
Entity Type:Organization
Organization Name:EPILEPSY ASSOCIATION OF WNY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-883-5396
Mailing Address - Street 1:339 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222
Mailing Address - Country:US
Mailing Address - Phone:716-883-5396
Mailing Address - Fax:716-883-5403
Practice Address - Street 1:339 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222
Practice Address - Country:US
Practice Address - Phone:716-883-5396
Practice Address - Fax:716-883-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01998498251B00000X
NY11371A251V00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01998498Medicaid
NY11371AMedicare ID - Type UnspecifiedMEDICARE GROUP #