Healthcare Provider Details

I. General information

NPI: 1265454482
Provider Name (Legal Business Name): JAMES H RABER N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2658 MAIN ST
NEWFANE NY
14108-1033
US

IV. Provider business mailing address

2658 MAIN ST
NEWFANE NY
14108-1033
US

V. Phone/Fax

Practice location:
  • Phone: 716-778-8627
  • Fax: 716-778-8059
Mailing address:
  • Phone: 716-778-8627
  • Fax: 716-778-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number333601
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF333601-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: