Basic Information
| Provider Information | |||||||||
| NPI: | 1952319725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARABA | ||||||||
| FirstName: | JANEL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 ESSJAY RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166301219 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 ESSJAY RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166301167 | ||||||||
| FaxNumber: | 7162505960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 11/06/2018 | ||||||||
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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 | 363A00000X | 006148-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 00026520301 | 01 | NY | UNIVERA | OTHER | 9512302 | 01 | NY | IHA | OTHER | 000570189003 | 01 | NY | HEALTH NOW | OTHER | 01994403 | 05 | NY | MEDICAID | 161000580 | 01 | NY | NOVA | OTHER | 970012314 | 01 | NY | RR MEDICARE | OTHER |