Organization
BUFFALO SUBURBAN I.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEDARNATH JAVALY M.D. (OWNER)
(716) 447-6903
Entity
Organization
Contact information
Practice address
2914 ELMWOOD AVE, SUITE 2, KENMORE, NY 14217-1332
(716) 447-6903
Mailing address
67 MAIN STREET, HAMBURG, NY 14075-4904
(716) 649-0887
(716) 646-4611
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
164017
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00027194102
UNIVERA
NY
01
—
000528147003
BLUE CROSS
NY
01
—
3412917
INDEPENDENT HEALTH
NY
01
—
DG5745
RAILROAD MEDICARE
NY
Enumeration date
10/09/2007
Last updated
02/21/2008
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