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General NPI Number Information
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NPI Number | 1427130889
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Entity Type | Organization
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Legal Business Name | M A STUTZMAN ADDICTION TREATMENT CENTER
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 360 FOREST AVENUE
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City | BUFFALO
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State | NY
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Zip | 14213-1298
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Country | US
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Telephone | 716-882-4900
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Fax | 716-882-4426
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Provider Business Mailing Address
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Address Line | 360 FOREST AVENUE
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City | BUFFALO
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State | NY
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Zip | 14213-1298
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Country | US
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Telephone | 716-882-4900
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Fax | 716-882-4426
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Authorized Official
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Title or Position | ASSOCIATE COMMISSIONER DIVISION OF
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Name | MR. MICHAEL A LAWLER
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Credential |
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Telephone | 518-457-5312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NY
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