MEDICARE: NIAGARA LABMASTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1144408063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIAGARA LABMASTERS

Provider Business Mailing Address
First Line	:	2342 NIAGARA FALLS BLVD
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-4759
Country	:	US
Telephone Number	:	716-694-4388
Fax Number	:	716-694-1140

Provider Business Practice Location Address
First Line	:	2342 NIAGARA FALLS BLVD
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-4759
Country	:	US
Telephone Number	:	716-694-4388
Fax Number	:	716-694-1140

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MR. RICHARD B KOMM
Credential	:	OPTICIAN
Telephone Number	:	716-694-4388

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/02/2008

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1841472552 — DR. DAVID SHUBERT RPH, PH.D.
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