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NPI Code Detail

MEDICARE: JENNIFER M KIELBASA RPA C

MEDICARE: JENNIFER M KIELBASA RPA 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
1363A00000XPhysician Assistant007549NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19512321OTHERNYINDEP HEALTH
2000570275001OTHERNYBLUE CROSS COMM BLUE
300027046701OTHERNYUNIVERA

General Provider Information

NPI Number : 1942283031
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER M KIELBASA RPA C
Provider Business Mailing Address
First Line : 6255 SHERIDAN DR
Second Line : STE 108
City : WILLIAMSVILLE
State : NY
Zip : 14221-4825
Country : US
Telephone Number : 716-630-1219
Fax Number : 716-817-1726
Provider Business Practice Location Address
First Line : 6460 MAIN ST
Second Line : BUFFALO CARDIOLOGY AND PULMONARY ASSOC PC
City : WILLIAMSVILLE
State : NY
Zip : 14221-5838
Country : US
Telephone Number : 716-634-5100
Fax Number : 716-634-5134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 06/17/2016

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