Healthcare Provider Details

I. General information

NPI: 1871404079
Provider Name (Legal Business Name): CHRISTOPHER HIDALGO LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 SHERIDAN DR
AMHERST NY
14226-1738
US

IV. Provider business mailing address

305 HERKIMER ST
BUFFALO NY
14213-1323
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-9999
  • Fax:
Mailing address:
  • Phone: 631-487-8103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003428-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: