Basic Information
| Provider Information | |||||||||
| NPI: | 1467406801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BUFFALO ENDOCRINOLOGY, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 HARLEM RD | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142241151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163322121 | ||||||||
| FaxNumber: | 7163322122 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 HARLEM RD | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142241151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163322121 | ||||||||
| FaxNumber: | 7163322122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | TONI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7163322121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 01574336 | 05 | NY | MEDICAID |