=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366797557
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH ANN BISHOP R PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2012
-----------------------------------------------------
Last Update Date | 07/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4250 FEDERAL DR IMMIGRATION HEALTH SERVICES- BFDF
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14020-1094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-344-5167
-----------------------------------------------------
Fax | 585-345-1896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4250 FEDERAL DR IMMIGRATION HEALTH SERVICES- BFDF
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14020-1094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-344-5167
-----------------------------------------------------
Fax | 585-345-1896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 009997-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------