Organization
MARY AGNES MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANNY ZYSKIND (ASSISTANT ADMINISTRATOR)
(716) 791-4211
Entity
Organization
Contact information
Practice address
307 PORTER AVE, BUFFALO, NY 14201-1031
(716) 881-0565
Mailing address
307 PORTER AVE, BUFFALO, NY 14201-1031
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
1753L001
NY
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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