MEDICARE: BUFFALO ATHLETIC CLUB SUBURBAN, INC.

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1962736066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUFFALO ATHLETIC CLUB SUBURBAN, INC.

Provider Business Mailing Address
First Line	:	1185 NIAGARA FALLS BLVD
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14226-1103
Country	:	US
Telephone Number	:	716-833-5226
Fax Number	:	716-833-7752

Provider Business Practice Location Address
First Line	:	1185 NIAGARA FALLS BLVD
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14226-1103
Country	:	US
Telephone Number	:	716-833-5226
Fax Number	:	716-833-7752

Authorized Official
Title or Position	:	SENIOR BUSINESS MANAGER
Name	:	MRS. ROSE MARIE PLESH
Credential	:
Telephone Number	:	716-833-5226

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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