Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 228134 | NY |
NPI | 1013192053 |
---|---|
Provider Name | Dr. Mary Ellen Emborsky |
First Address | Buffalo, NY 14203-1009 |
Second Address | Buffalo, NY 14203-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2008 |
Last Update Date | 31/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00026388701 | UNIVERA (01) | |
000527296001 | BC/BS (01) | |
02396683 | (05) | NY |
040426003102 | FIDELIS (01) | |
1292496 | IHA (01) | |
H84485 | (02) |