Healthcare Provider Details

I. General information

NPI: 1114434446
Provider Name (Legal Business Name): FREDERICK BATTEAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 MAIN ST
BUFFALO NY
14209-1912
US

IV. Provider business mailing address

227 THORN AVE
ORCHARD PARK NY
14127-2600
US

V. Phone/Fax

Practice location:
  • Phone: 716-832-1251
  • Fax: 716-832-1271
Mailing address:
  • Phone: 716-662-2040
  • Fax: 716-662-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37119
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberNYCPS2287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: