Provider Demographics
NPI:1134626450
Name:SCHAFFER, GARY JR
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SCHAFFER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ASHFORD AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8564
Mailing Address - Country:US
Mailing Address - Phone:716-622-1158
Mailing Address - Fax:
Practice Address - Street 1:212 ASHFORD AVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8564
Practice Address - Country:US
Practice Address - Phone:716-622-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool