Provider Demographics
NPI:1962479634
Name:RALBOVSKY, MICHAEL PETER (FNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PETER
Last Name:RALBOVSKY
Suffix:
Gender:M
Credentials:FNP
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 AVE
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:716-566-5007
Mailing Address - Fax:
Practice Address - Street 1:2128 ELMWOOD AVE
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:716-566-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3343491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000268570001OtherUNIVERA COMMERCIAL
00026857001OtherASO
000560900001OtherCOMMUNITY BLUE STANDARD
NY01465154Medicaid
7599258OtherGROUP HEALTH INS PPO CMP
000560900001OtherBCBS WNY
000560900001OtherCOMMUNITY CARE
041116000013OtherFIDELIS FAMILY HEALTH PLU
000560900001OtherSENIOR BLUE
000560900001OtherCHILD HEALTH PLUS FAMILY
041116000013OtherFIEDLIS CHILD HEALTH PLUS
000262857001OtherUNIVERA HEALTHCARE TRADIT
000560900001OtherCB LABOR HEALTH
041116000013OtherFIDELIS
000000092079OtherGROUP HEALTH INS HMO
000560900001OtherCB ADVANTAGE
000560900001OtherTRADITIONAL SECURE BLUE
00056090001OtherHMO 100
000560900001OtherCB LABOR HEALTH
000560900001OtherTRADITIONAL SECURE BLUE