Basic Information
| Provider Information | |||||||||
| NPI: | 1033119284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARBATKIN | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3176 ABBOTT ROAD | ||||||||
| Address2: | BUILDING A SUITE 500 | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168222117 | ||||||||
| FaxNumber: | 7168228165 | ||||||||
| Practice Location | |||||||||
| Address1: | 3176 ABBOTT ROAD | ||||||||
| Address2: | BUILDING A SUITE 500 | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168222117 | ||||||||
| FaxNumber: | 7168228165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C52221 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 202482 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2083A0300X | C52221 | CA | N | 2083A0300X | 202482 | NY | Y |
ID Information
| ID | Type | State | Issuer | Description | 202482 | 05 | NY | MEDICAID |