Basic Information
| Provider Information | |||||||||
| NPI: | 1851331839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FABIANSKI | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | R.P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168545700 | ||||||||
| FaxNumber: | 7168545800 | ||||||||
| Practice Location | |||||||||
| Address1: | 3810 TAYLOR RD | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141272232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168545700 | ||||||||
| FaxNumber: | 7166776407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 006393-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 000570176001 | 01 | NY | BLUE CROSS | OTHER | 9512181 | 01 | NY | INDEPENDENT HEALTH | OTHER | 01864846 | 05 | NY | MEDICAID |