Provider Demographics
NPI:1619125895
Name:STATE UNIVERSITY OF NEW YORK AT BUFFALO
Entity Type:Organization
Organization Name:STATE UNIVERSITY OF NEW YORK AT BUFFALO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-898-5509
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE ,ERIE COUNTY MEDICAL CENTER
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-5509
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE ,ERIE COUNTY MEDICAL CENTER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-30
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital