Provider Demographics
NPI:1952319725
Name:LARABA, JANEL B (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:B
Last Name:LARABA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5782
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:
Practice Address - Street 1:325 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8243
Practice Address - Country:US
Practice Address - Phone:716-630-1167
Practice Address - Fax:716-250-5960
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006148-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026520301OtherUNIVERA
NY9512302OtherIHA
NY000570189003OtherHEALTH NOW
NY01994403Medicaid
NY161000580OtherNOVA
NY970012314OtherRR MEDICARE
NY00026520301OtherUNIVERA
NY9512302OtherIHA