Provider Demographics
NPI:1164641361
Name:TRIGOBOFF, EILEEN (DNS)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:TRIGOBOFF
Suffix:
Gender:F
Credentials:DNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 MAIN ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-689-4561
Mailing Address - Fax:716-689-8325
Practice Address - Street 1:5820 MAIN ST
Practice Address - Street 2:SUITE 402
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5776
Practice Address - Country:US
Practice Address - Phone:716-689-4561
Practice Address - Fax:716-689-8325
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003380101YM0800X
NY3005361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS52391Medicare ID - Type Unspecified