Basic Information
| Provider Information | |||||||||
| NPI: | 1962479634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RALBOVSKY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2128 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165665007 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2128 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165665007 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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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 | 363LF0000X | F3343491 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 000268570001 | 01 | UNIVERA COMMERCIAL | OTHER | 00026857001 | 01 | ASO | OTHER | 000560900001 | 01 | COMMUNITY BLUE STANDARD | OTHER | 01465154 | 05 | NY | MEDICAID | 7599258 | 01 | GROUP HEALTH INS PPO CMP | OTHER | 000560900001 | 01 | BCBS WNY | OTHER | 000560900001 | 01 | COMMUNITY CARE | OTHER | 041116000013 | 01 | FIDELIS FAMILY HEALTH PLU | OTHER | 000560900001 | 01 | SENIOR BLUE | OTHER | 000560900001 | 01 | CHILD HEALTH PLUS FAMILY | OTHER | 041116000013 | 01 | FIEDLIS CHILD HEALTH PLUS | OTHER | 000262857001 | 01 | UNIVERA HEALTHCARE TRADIT | OTHER | 000560900001 | 01 | CB LABOR HEALTH | OTHER | 041116000013 | 01 | FIDELIS | OTHER | 000000092079 | 01 | GROUP HEALTH INS HMO | OTHER | 000560900001 | 01 | CB ADVANTAGE | OTHER | 000560900001 | 01 | TRADITIONAL SECURE BLUE | OTHER | 00056090001 | 01 | HMO 100 | OTHER |