Provider Demographics
NPI:1285774885
Name:ADMOZ, LORD (CASAC - T)
Entity type:Individual
Prefix:
First Name:LORD
Middle Name:
Last Name:ADMOZ
Suffix:
Gender:M
Credentials:CASAC - T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 OAKGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-1006
Mailing Address - Country:US
Mailing Address - Phone:716-885-3806
Mailing Address - Fax:
Practice Address - Street 1:6301 INDUCON DR E
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:NY
Practice Address - Zip Code:14132-9014
Practice Address - Country:US
Practice Address - Phone:716-731-2030
Practice Address - Fax:716-731-3010
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20688324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20688OtherCASAC - T