Provider Demographics
NPI:1497089262
Name:BAC FOR WOMEN COLVIN EGGERT, LLC
Entity Type:Organization
Organization Name:BAC FOR WOMEN COLVIN EGGERT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EMERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-348-3755
Mailing Address - Street 1:3157 EGGERT RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-7156
Mailing Address - Country:US
Mailing Address - Phone:716-348-3755
Mailing Address - Fax:716-348-3754
Practice Address - Street 1:3157 EGGERT RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-7156
Practice Address - Country:US
Practice Address - Phone:716-348-3755
Practice Address - Fax:716-348-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2225290120OtherBLUE CROSS BLUE SHEILD OF WNY