Provider Demographics
NPI:1013168194
Name:BUFFALO ULTRASOUND, IDTF
Entity Type:Organization
Organization Name:BUFFALO ULTRASOUND, IDTF
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 ST
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:716-631-2262
Mailing Address - Fax:716-631-8237
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:716-631-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02405181Medicaid
NY02405181Medicaid