Basic Information
Provider Information
NPI: 1073670915
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LACH
FirstName: JEFFREY
MiddleName: JOHN
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 425 ESSJAY RD STE 170
Address2:  
City: WILLIAMSVILLE
State: NY
PostalCode: 142218235
CountryCode: US
TelephoneNumber: 7166301219
FaxNumber:  
Practice Location
Address1: 85 HIGH ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142031149
CountryCode: US
TelephoneNumber: 7166301000
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/02/2007
LastUpdateDate: 05/07/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X1073670915NYN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X1073670915NYY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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