Basic Information
| Provider Information | |||||||||
| NPI: | 1992735187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANSKI | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | PT DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | BOX 8000 DEPARTMENT 314 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142670002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162130772 | ||||||||
| FaxNumber: | 7163245004 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 UNION ROAD | ||||||||
| Address2: | |||||||||
| City: | W SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166568600 | ||||||||
| FaxNumber: | 7166561560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| 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 | 225100000X | 027383 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 02697372 | 05 | NY | MEDICAID |