Healthcare Provider Details

I. General information

NPI: 1124432489
Provider Name (Legal Business Name): HISPANOS UNIDOS DE BUFFALO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 VIRGINIA ST
BUFFALO NY
14201-1938
US

IV. Provider business mailing address

1776 CLAY AVE
BRONX NY
10457-7239
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-7110
  • Fax:
Mailing address:
  • Phone: 347-649-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: TOMAS DEL RIO
Title or Position: CFO
Credential:
Phone: 347-649-3083