Provider Demographics
NPI:1194876300
Name:MAIN BUFFALO PEDIATRICS LLP
Entity type:Organization
Organization Name:MAIN BUFFALO PEDIATRICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIEDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-837-0995
Mailing Address - Street 1:2924 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1706
Mailing Address - Country:US
Mailing Address - Phone:716-837-0995
Mailing Address - Fax:716-837-1203
Practice Address - Street 1:2924 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1706
Practice Address - Country:US
Practice Address - Phone:716-837-0995
Practice Address - Fax:716-837-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169949-1173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02772530Medicaid
NY01052620Medicaid
NY02288686Medicaid
NY02343800Medicaid