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General NPI Number Information
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NPI Number | 1235327834
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Entity Type | Organization
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Legal Business Name | BUFFALO SUBURBAN I.D., INC.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 2914 ELMWOOD AVE SUITE 2
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City | KENMORE
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State | NY
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Zip | 14217-1332
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Country | US
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Telephone | 716-447-6903
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Fax |
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Provider Business Mailing Address
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Address Line | 67 MAIN STREET
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City | HAMBURG
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State | NY
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Zip | 14075-4904
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Country | US
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Telephone | 716-649-0887
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Fax | 716-646-4611
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Authorized Official
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Title or Position | OWNER
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Name | KEDARNATH JAVALY
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Credential | M.D.
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Telephone | 716-447-6903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 164017
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License Number State | NY
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