1497752919 NPI number — EMILY A LEVANDUSKY P.A.

Table of content: EMILY A LEVANDUSKY P.A. (NPI 1497752919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497752919 NPI number — EMILY A LEVANDUSKY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVANDUSKY
Provider First Name:
EMILY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1497752919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3085 HARLEM RD
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-2591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-844-5600
Provider Business Mailing Address Fax Number:
716-844-5750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3085 HARLEM RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14225-2563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-844-5000
Provider Business Practice Location Address Fax Number:
716-844-5050
Provider Enumeration Date:
06/30/2005

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: 363A00000X , with the licence number:  008310-1 , 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: 060511000055 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02343204 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9511906 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000570356001 . This is a "BCBS OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 125081 . This is a "WORKERS COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026566201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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