1457319618 NPI number — DR. ANGELO M DELBALSO MD

Table of content: DR. ANGELO M DELBALSO MD (NPI 1457319618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457319618 NPI number — DR. ANGELO M DELBALSO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELBALSO
Provider First Name:
ANGELO
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1457319618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 BOUNDBROOK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14051-1653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-689-0428
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3495 BAILEY 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:
14215-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-834-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2006

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: 2085R0202X , with the licence number:  139638 , 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: 00025344603 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1608497 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4195935 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040426000279 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 197582FF . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00028814 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000510133012 . This is a "BLUE SHIELD WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01144090 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396381W . This is a "NYS WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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