Active NPI
Tina Dubeck
- Nurse Practitioner
- Buffalo, NY
National Provider Identifier
1124597521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 657297
- Practice address
- 462 Grider St
Buffalo, NY 14215-3021 - Phone
- (716) 961-6995
- Fax
- (716) 898-5193
- NPI assigned
- Nov 15, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 657297 | NY | Primary |
Addresses
Primary practice location
462 Grider St
Buffalo, NY 14215-3021
Mailing address
PO Box 708760
Sandy, UT 84070-8760
Phone (801) 352-9500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 657297 | NY | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gastrointestinal Group | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Gastroenterology Physician
- Rochester, NY
- NPI 1114977048
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542240000000",
"number": "1124597521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 708760",
"city": "SANDY",
"state": "UT",
"postal_code": "840708760",
"telephone_number": "801-352-9500",
"fax_number": "801-352-7976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "462 GRIDER ST",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142153021",
"telephone_number": "716-961-6995",
"fax_number": "716-898-5193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBECK",
"first_name": "TINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-15",
"last_updated": "2018-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NY",
"license": "657297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.