Healthcare Provider Details

I. General information

NPI: 1861154759
Provider Name (Legal Business Name): STATE UNIVERSITY OF NEW YORK AT BUFFALO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 BIOMEDICAL EDUCATION BUILDING
BUFFALO NY
14214
US

IV. Provider business mailing address

52 BIOMEDICAL EDUCATION BUILDING
BUFFALO NY
14214
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-3980
  • Fax: 716-829-3974
Mailing address:
  • Phone: 716-829-3980
  • Fax: 716-829-3974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LAURA HUBBARD
Title or Position: VICE PRESIDENT, FINANCE AND ADMINIS
Credential:
Phone: 716-645-5124