Provider Demographics
NPI:1558549477
Name:NIAGARA LABMASTERS, INC.
Entity Type:Organization
Organization Name:NIAGARA LABMASTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:KOMM
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:716-694-4388
Mailing Address - Street 1:1635 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1745
Mailing Address - Country:US
Mailing Address - Phone:716-297-9115
Mailing Address - Fax:716-297-4270
Practice Address - Street 1:1635 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1745
Practice Address - Country:US
Practice Address - Phone:716-297-9115
Practice Address - Fax:716-297-4270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIAGARA LABMASTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0509630001Medicare NSC