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General NPI Number Information
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NPI Number | 1003261371
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Entity Type | Organization
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Legal Business Name | BUFFALO DIETETICS PLLC
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 120 OAKRIDGE AVE
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City | KENMORE
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State | NY
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Zip | 14217-1163
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Country | US
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Telephone | 716-208-3343
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Fax |
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Provider Business Mailing Address
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Address Line | 168 NEWELL AVE
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City | TONAWANDA
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State | NY
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Zip | 14150-6208
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Country | US
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Telephone | 716-208-3343
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EMILY A WOOD
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Credential | RD CDN
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Telephone | 716-208-3343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 006658-1
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License Number State | NY
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