Provider Demographics
NPI:1740333525
Name:CHEEKTOWAGA MARYVALE UFSD
Entity type:Organization
Organization Name:CHEEKTOWAGA MARYVALE UFSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUCHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-631-7420
Mailing Address - Street 1:1050 MARYVALE DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2324
Mailing Address - Country:US
Mailing Address - Phone:716-631-7430
Mailing Address - Fax:716-635-4699
Practice Address - Street 1:1050 MARYVALE DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2324
Practice Address - Country:US
Practice Address - Phone:716-631-7430
Practice Address - Fax:716-635-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379313Medicaid