1255368171 NPI number — MS. ANN M LEITTEN OTRC

Table of content: MS. ANN M LEITTEN OTRC (NPI 1255368171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255368171 NPI number — MS. ANN M LEITTEN OTRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEITTEN
Provider First Name:
ANN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTRC
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:
1255368171
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:
2128 ELMWOOD AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14207-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-874-4500
Provider Business Mailing Address Fax Number:
716-874-8145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2128 ELMWOOD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14207-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-874-4500
Provider Business Practice Location Address Fax Number:
716-874-8145
Provider Enumeration Date:
06/27/2006

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 040511000063 . This is a "FIDELIS FAMILY HEALTH PLU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000670011001 . This is a "CHP FHP 201" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000733832001 . This is a "COMMUNITY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1600573 . This is a "GROUP HEALTH INS PPO CBP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000670011001 . This is a "BC BS WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01465154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040511000063 . This is a "FIDELIS CHILD HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040511000063 . This is a "NORTH AMERICAN PREFERRED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "ASO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040511000063 . This is a "FIDELIS MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000670011001 . This is a "COMMUNITY BLUE STD HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000670011001 . This is a "CB ADVANTAGE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000670011001 . This is a "TRADITIONAL SECURE BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7400120 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "UNIVERA HEALTHCARE TRAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "UNIVERA COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000670011001 . This is a "CB LABOR HEALTH HMO" identifier . This identifiers is of the category "OTHER".




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