Provider Demographics
NPI:1437474418
Name:PULSE HEALTH AND FITNESS
Entity Type:Organization
Organization Name:PULSE HEALTH AND FITNESS
Other - Org Name:JAT HEALTH AND FITNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:716-681-9455
Mailing Address - Street 1:2875 UNION RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1461
Mailing Address - Country:US
Mailing Address - Phone:716-681-9455
Mailing Address - Fax:716-681-9456
Practice Address - Street 1:2875 UNION ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227
Practice Address - Country:US
Practice Address - Phone:716-681-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020586305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization