Healthcare Provider Details

I. General information

NPI: 1124317599
Provider Name (Legal Business Name): GIRLS ON THE RUN OF BUFFALO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MIDDLESEX RD
BUFFALO NY
14216-3118
US

IV. Provider business mailing address

PO BOX 1271
BUFFALO NY
14213-7271
US

V. Phone/Fax

Practice location:
  • Phone: 716-400-1019
  • Fax:
Mailing address:
  • Phone: 716-400-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: KATIE JOYCE
Title or Position: COUNCIL DIRECTOR
Credential:
Phone: 716-400-1019