Healthcare Provider Details

I. General information

NPI: 1386626117
Provider Name (Legal Business Name): ANDREW M DYBALSKI RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MICHIGAN AVE
BUFFALO NY
14203-1514
US

IV. Provider business mailing address

4225 GENESEE ST STE 400
CHEEKTOWAGA NY
14225-1994
US

V. Phone/Fax

Practice location:
  • Phone: 716-854-5700
  • Fax: 716-854-5800
Mailing address:
  • Phone: 716-204-3200
  • Fax: 716-204-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number009369
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: