Provider Demographics
NPI:1942283031
Name:KIELBASA, JENNIFER M (RPA C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:KIELBASA
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:STE 108
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4825
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:6460 MAIN ST
Practice Address - Street 2:BUFFALO CARDIOLOGY AND PULMONARY ASSOC PC
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5838
Practice Address - Country:US
Practice Address - Phone:716-634-5100
Practice Address - Fax:716-634-5134
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007549363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512321OtherINDEP HEALTH
NY000570275001OtherBLUE CROSS COMM BLUE
NY00027046701OtherUNIVERA
NY9512321OtherINDEP HEALTH