Great Lakes Erie Medical Imaging LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

GREAT LAKES ERIE MEDICAL IMAGING LLC

Practice address

462 Grider St
Buffalo, NY 14215-3021

Phone

(716) 898-3000

NPI assigned

Sep 29, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sarah Glenn-Smith, MBA

Title

Chief Executive Officer

Phone

(716) 836-4646

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443484800000",
    "number": "1972973345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 PARK CLUB LN STE 300",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215269",
            "telephone_number": "716-836-4646",
            "fax_number": "716-836-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 GRIDER ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153021",
            "telephone_number": "716-898-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ERIE MEDICAL IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-29",
        "last_updated": "2015-09-29",
        "status": "A",
        "authorized_official_last_name": "GLENN-SMITH",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "716-836-4646",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Grayson, PA-C
• Elizabeth M Graziano
• Matthew J Graziano, PA
• Melissa Ann Graziano, PT
• Great Lakes Anesthesiology, PC
• Great Lakes Orthopedic Labs, Inc
• Great Lanes Transportation LLC
• Greater Buffalo Accident & Injury Chiropractic
• Greater Buffalo Orthodontics
• Greater Buffalo Physical Therapy PC

• Diagnostic Radiology Physician in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.