1972736825 NPI number — MR. DEREK M AUBE-MARCHANT RPA-C

Table of content: MR. DEREK M AUBE-MARCHANT RPA-C (NPI 1972736825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972736825 NPI number — MR. DEREK M AUBE-MARCHANT RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUBE-MARCHANT
Provider First Name:
DEREK
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARCHANT
Provider Other First Name:
DEREK
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972736825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2015
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 104
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-8053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-636-7990
Provider Business Mailing Address Fax Number:
716-636-7993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3950 E ROBINSON RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14228-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-564-1111
Provider Business Practice Location Address Fax Number:
716-564-1128
Provider Enumeration Date:
08/26/2009

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:  013319-1 , 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)





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