1689718256 NPI number — MR. EARNEST RODELL DONALSON BA

Table of content: MR. EARNEST RODELL DONALSON BA (NPI 1689718256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689718256 NPI number — MR. EARNEST RODELL DONALSON BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONALSON
Provider First Name:
EARNEST
Provider Middle Name:
RODELL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BA
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:
1689718256
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:
1526 WALDEN AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-4965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-895-7167
Provider Business Mailing Address Fax Number:
716-332-4483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
463 WILLIAM ST
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:
14204-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-852-0383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2007

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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