1205805314 NPI number — KATHLEEN L AEBISCHER PT

Table of content: KATHLEEN L AEBISCHER PT (NPI 1205805314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205805314 NPI number — KATHLEEN L AEBISCHER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AEBISCHER
Provider First Name:
KATHLEEN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINDAMAN
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205805314
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:
6301 TRANSIT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEPEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14043-1051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-684-0400
Provider Business Mailing Address Fax Number:
716-683-7028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 DELAWARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-694-5385
Provider Business Practice Location Address Fax Number:
716-694-5386
Provider Enumeration Date:
03/14/2006

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: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000623034002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9305841 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0404260003529 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6602438 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 812266 . This is a "MANAGED PHYSICAL NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011174501 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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