Provider Demographics
NPI:1104841980
Name:NACHREINER, ERIC JASON (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JASON
Last Name:NACHREINER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CRYSTAL LANE
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14050
Mailing Address - Country:US
Mailing Address - Phone:716-835-1123
Mailing Address - Fax:
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:@MERCY HOSPITAL OF BUFFALO
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-828-2434
Practice Address - Fax:716-828-3417
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007816-0363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02150934Medicaid
NYPA1005Medicare PIN
NYP26742Medicare UPIN
NYPA1005Medicare ID - Type UnspecifiedINDV.MEDICARE # FOR GROUP