Provider Demographics
NPI:1639822513
Name:BUFFALO CLINICAL LAB TESTING CORP.
Entity Type:Organization
Organization Name:BUFFALO CLINICAL LAB TESTING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCESCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-348-9042
Mailing Address - Street 1:169 WILMUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-2553
Mailing Address - Country:US
Mailing Address - Phone:716-348-9042
Mailing Address - Fax:
Practice Address - Street 1:734 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1510
Practice Address - Country:US
Practice Address - Phone:716-348-9042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service