1427024066 NPI number — BRIAN T POREBSKI DPT

Table of content: BRIAN T POREBSKI DPT (NPI 1427024066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427024066 NPI number — BRIAN T POREBSKI DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POREBSKI
Provider First Name:
BRIAN
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1427024066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2128 ELMWOOD AVENUE
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:
14207-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-874-4500
Provider Business Mailing Address Fax Number:
716-874-8145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2128 ELMWOOD AVENUE
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:
14207-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-874-4500
Provider Business Practice Location Address Fax Number:
716-874-8145
Provider Enumeration Date:
02/24/2006

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: 225100000X , with the licence number:  0222221 , 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: 160975538 . This is a "NORTH AMERICAN PREFERRED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "CHILDHEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "UNIVERA COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "UNIVERA MEDICARE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050801000038 . This is a "FIDELIS CHILD HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000626999001 . This is a "COMMUNITY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01465154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050801000038 . This is a "FIDELIS MEDICAIDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: ASO . This is a "00011249902" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160975538 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "UNIVERA TRANSITIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000626999001 . This is a "BCBS WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "UNIVERA HEALTHCARE TRADIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249902 . This is a "PLUSMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000626999001 . This is a "COMMUNITY BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160975538 . This is a "MAGNA CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6698654 . This is a "GROUP HEALTH INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050801000038 . This is a "FIDELIS FAMILY HEALTH PLU" identifier . This identifiers is of the category "OTHER".




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