1174679005 NPI number — JO-ANNE GRABOWSKI PH.D.

Table of content: JO-ANNE GRABOWSKI PH.D. (NPI 1174679005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174679005 NPI number — JO-ANNE GRABOWSKI PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRABOWSKI
Provider First Name:
JO-ANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1174679005
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:
525 WASHINGTON ST
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:
14203-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-856-4494
Provider Business Mailing Address Fax Number:
716-842-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 COLUMBUS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14227-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-894-2743
Provider Business Practice Location Address Fax Number:
716-896-6394
Provider Enumeration Date:
01/25/2007

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: 103T00000X , with the licence number:  00012694 , 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: 000360241501 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".




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