Healthcare Provider Details

I. General information

NPI: 1437459542
Provider Name (Legal Business Name): BUFFALO GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MAIN ST
BUFFALO NY
14202-1102
US

IV. Provider business mailing address

1010 MAIN ST
BUFFALO NY
14202-1102
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-4817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number22 605850
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number22 605850
License Number StateNY

VIII. Authorized Official

Name: REBEKAH BROWNSTEIN
Title or Position: NURSE COUNSELOR
Credential: RN
Phone: 716-859-4790