Provider Demographics
NPI:1568627339
Name:FETES, JAIME (PA)
Entity Type:Individual
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First Name:JAIME
Middle Name:
Last Name:FETES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3085 HARLEM RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5500
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:3085 HARLEM RD
Practice Address - Street 2:STE 200
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2563
Practice Address - Country:US
Practice Address - Phone:716-844-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2015-08-13
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Provider Licenses
StateLicense IDTaxonomies
NY012630-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01417481Medicaid
NYP00638154OtherRR MEDICARE
NYPA2722Medicare PIN