Provider Demographics
NPI:1619933710
Name:PAULUS, IRENE (MBBS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:PAULUS
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GARDENVILLE PKWY W
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1324
Mailing Address - Country:US
Mailing Address - Phone:716-857-6150
Mailing Address - Fax:716-656-4074
Practice Address - Street 1:1185 SWEET HOME RD
Practice Address - Street 2:AMHERST UNIVERSITY HEALTH CENTER
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-689-0040
Practice Address - Fax:716-568-2330
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00216003OtherMEDICARE RAILROAD #
NY0125189OtherGHI #
NY159880BJOtherPREFERRED CARE #
NY000527164002OtherHEALTH NOW BCBS #
NY0492653OtherIHA #
NY00026128701OtherUNIVERA #
NY040426002902OtherFIDELIS #
NY225987-7WOtherWORKERS COMP #
NY000527164002OtherHEALTH NOW BCBS #
NY225987-7WOtherWORKERS COMP #