Provider Demographics
NPI:1265632517
Name:DRABINSKI, THEODORA M (RN)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:M
Last Name:DRABINSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MCCAULEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1925
Mailing Address - Country:US
Mailing Address - Phone:607-733-7515
Mailing Address - Fax:
Practice Address - Street 1:148 MCCAULEY AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:14903-1925
Practice Address - Country:US
Practice Address - Phone:607-733-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY389434-1163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02704658Medicaid