Healthcare Provider Details

I. General information

NPI: 1366953713
Provider Name (Legal Business Name): GREATER BUFFALO UNITED ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 NIAGARA ST
BUFFALO NY
14201-1108
US

IV. Provider business mailing address

564 NIAGARA ST
BUFFALO NY
14201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 716-247-5282
  • Fax: 716-884-8096
Mailing address:
  • Phone: 716-247-5282
  • Fax: 716-884-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DR. RAUL VAZQUEZ
Title or Position: CEO
Credential: MD
Phone: 716-830-4840