Healthcare Provider Details

I. General information

NPI: 1467725101
Provider Name (Legal Business Name): 4459 BAILEY AVENUE OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4459 BAILEY AVE
AMHERST NY
14226-2129
US

IV. Provider business mailing address

500 SENECA ST STE 100
BUFFALO NY
14204-1963
US

V. Phone/Fax

Practice location:
  • Phone: 716-835-2543
  • Fax:
Mailing address:
  • Phone: 716-633-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02084839
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. JEFFREY RUBIN
Title or Position: CO-CHIEF EXECUTIVE OFFICER
Credential:
Phone: 716-817-5075