1720043680 NPI number — MS. SUE B OLEXENKO LCSWR

Table of content: MS. SUE B OLEXENKO LCSWR (NPI 1720043680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720043680 NPI number — MS. SUE B OLEXENKO LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLEXENKO
Provider First Name:
SUE
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
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:
1720043680
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:
2128 ELMWOOD AVE
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 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:
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:
04/20/2006

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: 1041C0700X , with the licence number:  R047691 , 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: 000526001001 . This is a "FAMILY HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050730000006 . This is a "FIDELIS FAMILY HEALTH PLS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "CHILD HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "COMM CARE MEDICAID MGD C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "HMO 100" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011249905 . This is a "ASO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "HEALTHLY NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "BCBS WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "COMMUNITY BLUE STD HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "SECURE BLUE POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "CB ADVANTAGE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "SECURE BLUE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "SECURE BLUE INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050730000006 . This is a "FIDELIS CHILD HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "CB LABOR HEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000526001001 . This is a "SENIOR BLUE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050730000006 . This is a "FIDELIS MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01465154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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