1932201829 NPI number — ILJA J WEINRIEB MD PC

Table of content: (NPI 1932201829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932201829 NPI number — ILJA J WEINRIEB MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ILJA J WEINRIEB MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1932201829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 YOUNGS RD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-636-9056
Provider Business Mailing Address Fax Number:
716-636-9750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 YOUNGS RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-636-9056
Provider Business Practice Location Address Fax Number:
716-636-9750
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINRIEB
Authorized Official First Name:
ILJA
Authorized Official Middle Name:
JULIUS
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
716-636-9056

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  134156 , 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: 000507599003 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2300804 . This is a "IHA" identifier . This identifiers is of the category "OTHER".




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