Basic Information
| Provider Information | |||||||||
| NPI: | 1619933710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAULUS | ||||||||
| FirstName: | IRENE | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 GARDENVILLE PKWY W | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142241324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168576150 | ||||||||
| FaxNumber: | 7166564074 | ||||||||
| Practice Location | |||||||||
| Address1: | 1185 SWEET HOME RD | ||||||||
| Address2: | AMHERST UNIVERSITY HEALTH CENTER | ||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166890040 | ||||||||
| FaxNumber: | 7165682330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 11/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 225987 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00216003 | 01 | NY | MEDICARE RAILROAD # | OTHER | 0125189 | 01 | NY | GHI # | OTHER | 159880BJ | 01 | NY | PREFERRED CARE # | OTHER | 000527164002 | 01 | NY | HEALTH NOW BCBS # | OTHER | 0492653 | 01 | NY | IHA # | OTHER | 00026128701 | 01 | NY | UNIVERA # | OTHER | 040426002902 | 01 | NY | FIDELIS # | OTHER | 225987-7W | 01 | NY | WORKERS COMP # | OTHER |