Healthcare Provider Details

I. General information

NPI: 1770886129
Provider Name (Legal Business Name): GATEWAY-LONGVIEW THERAPEUTIC PRESCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 GENESEE ST
BOWMANSVILLE NY
14026-1044
US

IV. Provider business mailing address

605 NIAGARA ST
BUFFALO NY
14201-1044
US

V. Phone/Fax

Practice location:
  • Phone: 716-783-3230
  • Fax:
Mailing address:
  • Phone: 716-883-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMES SAMPSON
Title or Position: PRESIDENT
Credential:
Phone: 716-783-3176