1699864686 NPI number — ALEXANDER M TRUSKINOVSKY MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699864686 NPI number — ALEXANDER M TRUSKINOVSKY MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TRUSKINOVSKY

Provider First Name:

ALEXANDER

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1699864686

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/22/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

ELM AND CARLTON 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:

14263-0001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

716-845-2300

Provider Business Mailing Address Fax Number:

716-845-3427

Provider First Line Business Practice Location Address:

ELM AND CARLTON ST

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:

14263-0001

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

716-845-2300

Provider Business Practice Location Address Fax Number:

716-845-3427

Provider Enumeration Date:

10/11/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207ZP0102X , with the licence number:  273884 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0079322 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 11-00014 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 11-00412 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: B514 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP57488 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 34560700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 2230946 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 608R8TR . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0581165 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 462493900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1042014 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 132342 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".