Provider Demographics
NPI:1972874675
Name:BUFFALO SYNAPSE SUPPORT, LLC
Entity type:Organization
Organization Name:BUFFALO SYNAPSE SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMBOULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-803-9624
Mailing Address - Street 1:609 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218
Mailing Address - Country:US
Mailing Address - Phone:716-803-9624
Mailing Address - Fax:
Practice Address - Street 1:609 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218
Practice Address - Country:US
Practice Address - Phone:716-803-9624
Practice Address - Fax:716-240-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC50239332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies