Healthcare Provider Details

I. General information

NPI: 1992114110
Provider Name (Legal Business Name): NYSARC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2643 MAIN ST
BUFFALO NY
14214-2015
US

IV. Provider business mailing address

2643 MAIN ST
BUFFALO NY
14214-2015
US

V. Phone/Fax

Practice location:
  • Phone: 716-833-8603
  • Fax: 706-833-8622
Mailing address:
  • Phone: 716-833-8603
  • Fax: 706-833-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE TOTH
Title or Position: ASSOC DIRECTOR
Credential:
Phone: 716-833-8601