Provider Demographics
NPI:1851331839
Name:FABIANSKI, JASON DANIEL (RPA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:FABIANSKI
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1536
Mailing Address - Country:US
Mailing Address - Phone:716-854-5700
Mailing Address - Fax:716-854-5800
Practice Address - Street 1:3810 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2232
Practice Address - Country:US
Practice Address - Phone:716-854-5700
Practice Address - Fax:716-677-6407
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006393-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000570176001OtherBLUE CROSS
NY9512181OtherINDEPENDENT HEALTH
NY01864846Medicaid
NY9512181OtherINDEPENDENT HEALTH
NY01864846Medicaid