Provider Demographics
NPI:1427024066
Name:POREBSKI, BRIAN T (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:POREBSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 ELMWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1910
Mailing Address - Country:US
Mailing Address - Phone:716-874-4500
Mailing Address - Fax:716-874-8145
Practice Address - Street 1:2128 ELMWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1910
Practice Address - Country:US
Practice Address - Phone:716-874-4500
Practice Address - Fax:716-874-8145
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0222221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
160975538OtherNORTH AMERICAN PREFERRED
00011249902OtherCHILDHEALTH PLUS
00011249902OtherUNIVERA COMMERCIAL
00011249902OtherUNIVERA MEDICARE PPO
050801000038OtherFIDELIS CHILD HEALTH PLUS
000626999001OtherCOMMUNITY CARE
NY01465154Medicaid
050801000038OtherFIDELIS MEDICAIDS
ASOOther00011249902
160975538OtherEMPIRE
00011249902OtherUNIVERA TRANSITIONS
000626999001OtherBCBS WNY
00011249902OtherUNIVERA HEALTHCARE TRADIT
00011249902OtherPLUSMED
000626999001OtherCOMMUNITY BLUE
160975538OtherMAGNA CARE
6698654OtherGROUP HEALTH INSURANCE
050801000038OtherFIDELIS FAMILY HEALTH PLU
00011249902OtherUNIVERA COMMERCIAL
P83339Medicare UPIN