Provider Demographics
NPI:1013192053
Name:EMBORSKY, MARY ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:EMBORSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0220
Mailing Address - Fax:716-323-0293
Practice Address - Street 1:1001 MAIN ST FL 5
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0220
Practice Address - Fax:716-323-0293
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2281342080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000527296001OtherBC/BS
1292496OtherIHA
00026388701OtherUNIVERA
NY02396683Medicaid
040426003102OtherFIDELIS
DD5721Medicare PIN
H84485Medicare UPIN