| Buffalo Suburban I.d., Inc. | |
|
2914 Elmwood Ave Suite 2 Kenmore NY 14217-1332 | |
| (716) 447-6903 | |
| Not Available |
| Full Name | Buffalo Suburban I.d., Inc. |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 2914 Elmwood Ave, Kenmore, New York |
| Authorized Official Name and Position | Kedarnath Javaly (OWNER) |
| Authorized Official Contact | 7164476903 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Buffalo Suburban I.d., Inc. 67 Main Street Hamburg NY 14075-4904 Ph: (716) 649-0887 | Buffalo Suburban I.d., Inc. 2914 Elmwood Ave Suite 2 Kenmore NY 14217-1332 Ph: (716) 447-6903 |
| NPI Number | 1235327834 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 02/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235327834 | NPI | - | NPPES |
| DG5745 | Other | NY | RAILROAD MEDICARE |
| 00027194102 | Other | NY | UNIVERA |
| 000528147003 | Other | NY | BLUE CROSS |
| 3412917 | Other | NY | INDEPENDENT HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 164017 (New York) | Primary |
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