| State Of New York Comptrollers Office | |
|
108a Squire Hall Buffalo NY 14214-3008 | |
| (716) 829-2836 | |
| Not Available |
| Full Name | State Of New York Comptrollers Office |
|---|---|
| Speciality | Clinic/Center |
| Location | 108a Squire Hall, Buffalo, New York |
| Authorized Official Name and Position | James Michel Harris (ASSISTANT DEAN) |
| Authorized Official Contact | 7168292336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of New York Comptrollers Office 325 Squire Hall Buffalo NY 14214-8006 Ph: (716) 829-2836 | State Of New York Comptrollers Office 108a Squire Hall Buffalo NY 14214-3008 Ph: (716) 829-2836 |
| NPI Number | 1861551798 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 01/11/2018 |
| Medicare PECOS PAC ID | 0840101770 |
|---|---|
| Medicare Enrollment ID | O20180509001549 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861551798 | NPI | - | NPPES |
| 01712734 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 1401226R (New York) | Primary |
| Provider Name | Joseph E Gambacorta |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1881808954 PECOS PAC ID: 1557625043 Enrollment ID: I20180509001879 |
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