Active NPI
Egbert L Swoboda, MD
- Pediatrics Physician
- Buffalo, NY
National Provider Identifier
1891850723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 123292-1
- Practice address
- 1500 Broadway St
Buffalo, NY 14212-1845 - Phone
- (716) 891-7711
- Fax
- (716) 891-2032
- NPI assigned
- Dec 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 123292-1 | NY | Primary |
Addresses
Primary practice location
1500 Broadway St
Buffalo, NY 14212-1845
Mailing address
3 Pinewood Dr
Orchard Park, NY 14127-4329
Phone (716) 649-8857
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00835401 | Medicaid | NY |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 123292-1 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891850723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 PINEWOOD DR",
"city": "ORCHARD PARK",
"state": "NY",
"postal_code": "141274329",
"telephone_number": "716-649-8857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 BROADWAY ST",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142121845",
"telephone_number": "716-891-7711",
"fax_number": "716-891-2032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWOBODA",
"first_name": "EGBERT",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "123292-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00835401",
"state": "NY"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.