MEDICARE: JASON DANIEL FABIANSKI R.P.A.-C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	006393-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000570176001	OTHER	NY	BLUE CROSS
2	9512181	OTHER	NY	INDEPENDENT HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851331839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON DANIEL FABIANSKI R.P.A.-C.

Provider Business Mailing Address
First Line	:	700 MICHIGAN AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14203-1536
Country	:	US
Telephone Number	:	716-854-5700
Fax Number	:	716-854-5800

Provider Business Practice Location Address
First Line	:	3810 TAYLOR RD
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-2232
Country	:	US
Telephone Number	:	716-854-5700
Fax Number	:	716-677-6407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	04/14/2021

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