Organization
BUFFALO ATHLETIC CLUB FOR WOMEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD RUGG (OWNER)
(716) 845-6660
Entity
Organization
Contact information
Practice address
480 EVANS ST, WILLIAMSVILLE, NY 14221-5670
(716) 634-7867
Mailing address
480 EVANS ST, WILLIAMSVILLE, NY 14221-5670
(716) 634-7867
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000585071001
BLUE CROSS/BLUE SHIELD OF WESTERN NEW YORK
NY
Enumeration date
09/24/2009
Last updated
09/24/2009
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