Provider Demographics
NPI:1023457959
Name:LOBIANCO, JOHN JAMES (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:LOBIANCO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:192 PARK CLUB LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-204-1101
Mailing Address - Fax:716-204-8528
Practice Address - Street 1:192 PARK CLUB LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-204-1101
Practice Address - Fax:716-204-8528
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2020-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY016605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400091296Medicare UPIN