=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376920900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPEER OF GREATER BUFFALO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2015
-----------------------------------------------------
Last Update Date | 05/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 DELAWARE AVE SUITE 210
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14202-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-883-3331
-----------------------------------------------------
Fax | 716-883-3395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 DELAWARE AVENUE SUITE 210
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14202-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-883-3331
-----------------------------------------------------
Fax | 716-883-3395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. DANIEL COLPOYS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-883-3331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------