Healthcare Provider Details

I. General information

NPI: 1790892826
Provider Name (Legal Business Name): BUFFALO ULTRASOUND, IDTF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 EVANS ST
WILLIAMSVILLE NY
14221-5626
US

IV. Provider business mailing address

388 EVANS STREET
WILLIAMSVILLE NY
14221-5626
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-2262
  • Fax: 716-631-2317
Mailing address:
  • Phone: 716-634-8800
  • Fax: 716-634-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL STRAECK JR.
Title or Position: PRESIDENT
Credential:
Phone: 716-631-2262