Provider Demographics
NPI:1790892826
Name:BUFFALO ULTRASOUND, IDTF INC
Entity Type:Organization
Organization Name:BUFFALO ULTRASOUND, IDTF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:716-631-2262
Mailing Address - Street 1:388 EVANS STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5626
Mailing Address - Country:US
Mailing Address - Phone:716-634-8800
Mailing Address - Fax:716-634-8987
Practice Address - Street 1:388 EVANS ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5626
Practice Address - Country:US
Practice Address - Phone:716-631-2262
Practice Address - Fax:716-631-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2471B0102X, 2471C3402X, 2471S1302X, 2471V0105X, 261QR0208X
293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011172401OtherUNIVERA
NY1610947OtherINDEPENDENT HEALTH
NY470000919OtherRAILROAD MEDICARE
NY0051047011OtherBC/BS WNY
NY630001671OtherRAILROAD MEDICARE
NYP010169198OtherBC/BS ROCHESTER
NY02405181Medicaid
NY4100574OtherGHI
NY0051047011OtherBC/BS WNY
NY02405181Medicaid
NY=========OtherUNITED HEALTHCARE
NYP010169198OtherBC/BS ROCHESTER