Healthcare Provider Details

I. General information

NPI: 1659647774
Provider Name (Legal Business Name): HISPANIC UNITED OF BUFFALO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 VIRGINIA ST
BUFFALO NY
14201-1938
US

IV. Provider business mailing address

254 VIRGINIA ST
BUFFALO NY
14201-1938
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-7110
  • Fax: 716-856-9617
Mailing address:
  • Phone: 716-856-7110
  • Fax: 716-856-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: MS. LOURDES TERESA IGLESIAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 716-856-7110