Basic Information
| Provider Information | |||||||||
| NPI: | 1427024066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POREBSKI | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2128 ELMWOOD AVENUE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Practice Location | |||||||||
| Address1: | 2128 ELMWOOD AVENUE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0222221 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 160975538 | 01 | NORTH AMERICAN PREFERRED | OTHER | 00011249902 | 01 | CHILDHEALTH PLUS | OTHER | 00011249902 | 01 | UNIVERA COMMERCIAL | OTHER | 00011249902 | 01 | UNIVERA MEDICARE PPO | OTHER | 050801000038 | 01 | FIDELIS CHILD HEALTH PLUS | OTHER | 000626999001 | 01 | COMMUNITY CARE | OTHER | 01465154 | 05 | NY | MEDICAID | 050801000038 | 01 | FIDELIS MEDICAIDS | OTHER | ASO | 01 | 00011249902 | OTHER | 160975538 | 01 | EMPIRE | OTHER | 00011249902 | 01 | UNIVERA TRANSITIONS | OTHER | 000626999001 | 01 | BCBS WNY | OTHER | 00011249902 | 01 | UNIVERA HEALTHCARE TRADIT | OTHER | 00011249902 | 01 | PLUSMED | OTHER | 000626999001 | 01 | COMMUNITY BLUE | OTHER | 160975538 | 01 | MAGNA CARE | OTHER | 6698654 | 01 | GROUP HEALTH INSURANCE | OTHER | 050801000038 | 01 | FIDELIS FAMILY HEALTH PLU | OTHER |