Basic Information
Provider Information | |||||||||
NPI: | 1427014448 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NOTINO | ||||||||
FirstName: | ANTHONY | ||||||||
MiddleName: | G | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1368 | ||||||||
Address2: |   | ||||||||
City: | WILLIAMSVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 142311368 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168592954 | ||||||||
FaxNumber: | 7168592962 | ||||||||
Practice Location | |||||||||
Address1: | 100 HIGH ST | ||||||||
Address2: |   | ||||||||
City: | BUFFALO | ||||||||
State: | NY | ||||||||
PostalCode: | 142031126 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168592954 | ||||||||
FaxNumber: | 7168592962 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/26/2006 | ||||||||
LastUpdateDate: | 05/06/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 209092 | NY | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 2090926W | 01 | NY | WORKERS COMPENSATION | OTHER | 00026429107 | 01 |   | UNIVERA | OTHER | 00026429101 | 01 |   | UNIVERA | OTHER | 000527412008 | 01 |   | BLUE SHIELD WNY | OTHER | 02458051 | 05 | NY |   | MEDICAID | 4194881 | 01 |   | GHI | OTHER | P00081480 | 01 |   | RR MEDICARE | OTHER | P010209092 | 01 |   | BLUE CHOICE | OTHER | 0142862 | 01 |   | GHI | OTHER | 200928832 | 01 |   | EMPIRE | OTHER | 1611710 | 01 |   | INDEPENDENT HEALTH | OTHER | P00061160 | 01 |   | RAILROAD MEDICARE | OTHER | P020209092 | 01 |   | BLUE SHIELD ROCHESTER | OTHER | P010209092 | 01 |   | BLUE SHIELD | OTHER | 00026429105 | 01 |   | UNIVERA | OTHER | 000527412001 | 01 |   | BLUE SHIELD WNY | OTHER | 000527412006 | 01 |   | BLUE SHIELD WNY | OTHER | 040426003197 | 01 |   | FIDELIS | OTHER | 195510FF | 01 |   | PREFERRED CARE | OTHER | P040209092 | 01 |   | ROCHESTER BLUE SHIELD | OTHER |