1669567749 NPI number — LYNN HERNAN MD

Table of content: LYNN HERNAN MD (NPI 1669567749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669567749 NPI number — LYNN HERNAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNAN
Provider First Name:
LYNN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669567749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4511 HARLEM RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-3822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-839-6720
Provider Business Mailing Address Fax Number:
716-839-6740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 BRYANT ST
Provider Second Line Business Practice Location Address:
PEDIATRIC CRITICAL CARE UNIT
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14222-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-878-7442
Provider Business Practice Location Address Fax Number:
716-878-7101
Provider Enumeration Date:
10/04/2006

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: 2080P0203X , with the licence number:  189246 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01339151 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0014385880001 . This is a "PA MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426000964 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9409269 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2640780 . This is a "OHIO MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010075901 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000524363001 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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