Provider Demographics
NPI:1588743702
Name:UNIVERSITY PSYCHIATRIC PRACTICE, INC
Entity type:Organization
Organization Name:UNIVERSITY PSYCHIATRIC PRACTICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-898-4884
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:ECMC, ROOM 1168
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-4884
Mailing Address - Fax:716-898-4447
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:ECMC, ROOM 1168
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-4884
Practice Address - Fax:716-898-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01398338Medicaid
NY01398338Medicaid