Provider Demographics
NPI:1346574233
Name:BUFFALO ATHLETIC CLUB FOR WOMEN
Entity Type:Organization
Organization Name:BUFFALO ATHLETIC CLUB FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-845-6660
Mailing Address - Street 1:480 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5670
Mailing Address - Country:US
Mailing Address - Phone:716-634-7867
Mailing Address - Fax:
Practice Address - Street 1:480 EVANS ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5670
Practice Address - Country:US
Practice Address - Phone:716-634-7867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000585071001OtherBLUE CROSS/BLUE SHIELD OF WESTERN NEW YORK