Provider Demographics
NPI:1972781854
Name:DOBASH, ROSEANNE M (FNP)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:M
Last Name:DOBASH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 ABBOTT ROD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2039
Mailing Address - Country:US
Mailing Address - Phone:716-828-2578
Mailing Address - Fax:716-828-2744
Practice Address - Street 1:565 ABBOTT ROD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-828-2578
Practice Address - Fax:716-828-2744
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332863-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560881004OtherBLUE CROSS
NY9512545OtherINDEPENDENT HEALTH ASSOCIATION
NY00026797104OtherUNIVERA
NY080415000021OtherFIDELIS
NY02552803Medicaid
NY02552803Medicaid
NYQ22528Medicare UPIN