1588630453 NPI number — DR. ALAN THOMAS AQUILINA MD

Table of content: DR. ALAN THOMAS AQUILINA MD (NPI 1588630453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588630453 NPI number — DR. ALAN THOMAS AQUILINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AQUILINA
Provider First Name:
ALAN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1588630453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 OLD SPRING LN STE 320
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:
14221-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-861-4790
Provider Business Mailing Address Fax Number:
716-204-8229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SLEEP LAB OF OLEAN GENERAL
Provider Second Line Business Practice Location Address:
515 MAIN ST
Provider Business Practice Location Address City Name:
OLEAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-373-9300
Provider Business Practice Location Address Fax Number:
716-701-1543
Provider Enumeration Date:
02/28/2006

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: 207RP1001X , with the licence number:  125476 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 125476 , 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: 00601809 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005078231 . This is a "HEALTH NOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2807596 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010005303 . This is a "EXCELLUS UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".