1467898387 NPI number — TIFFANY MARIE FABIAN DNP

Table of content: TIFFANY MARIE FABIAN DNP (NPI 1467898387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467898387 NPI number — TIFFANY MARIE FABIAN DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FABIAN
Provider First Name:
TIFFANY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP
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:
1467898387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 CORPORATE WAY STE 2M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY COTTAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10989-2027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-362-1411
Provider Business Mailing Address Fax Number:
718-362-1651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
346 DELAWARE AVE
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:
14202-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-856-7500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2013

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: 163W00000X , with the licence number:  621539-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: F310220 , 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)