1033128087 NPI number — KAREN M JANKOWSKI

Table of content: KAREN M JANKOWSKI (NPI 1033128087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033128087 NPI number — KAREN M JANKOWSKI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANKOWSKI
Provider First Name:
KAREN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033128087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CARTER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-338-4793
Provider Business Mailing Address Fax Number:
585-336-4845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 EMPIRE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-668-6170
Provider Business Practice Location Address Fax Number:
716-656-4074
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 133V00000X , with the licence number: 003876 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00245097 . This is a "MEDICARE RAILROAD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000525934004 . This is a "HEALTH NOW BCBS # FOR ED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426003363 . This is a "FIDELIS CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6510049 . This is a "IHA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011283017 . This is a "UNIVERA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000525932005 . This is a "HEALTH NOW BCBS # FOR AU" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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