Individual provider Active NPI

Egbert L Swoboda, MD

  • Pediatrics Physician
  • Buffalo, NY
National Provider Identifier
1891850723
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
123292-1 Issued in NY
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

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
00835401MedicaidNY

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

LicenseStateTypeSpecialty
123292-1NYMDPediatrics 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.

Verify at the official NPI Registry.