1326097403 NPI number — DR. ALEXANDER V ROVNER M.D.

Table of content: DR. ALEXANDER V ROVNER M.D. (NPI 1326097403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326097403 NPI number — DR. ALEXANDER V ROVNER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROVNER
Provider First Name:
ALEXANDER
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1326097403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 GRAND ISLAND BLVD
Provider Second Line Business Mailing Address:
C
Provider Business Mailing Address City Name:
GRAND ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14072-2171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-404-2604
Provider Business Mailing Address Fax Number:
716-404-2692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 GRAND ISLAND BLVD
Provider Second Line Business Practice Location Address:
# C
Provider Business Practice Location Address City Name:
GRAND ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14072-2171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-913-3917
Provider Business Practice Location Address Fax Number:
716-404-2692
Provider Enumeration Date:
05/08/2006

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: 2084N0402X , with the licence number:  TMD005190 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0402X , with the licence number: MD473816 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0402X , with the licence number: 238610-1 , 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: 02798570 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".