Provider Demographics
NPI:1043537996
Name:AMBORSKI, ERIN E (PA)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:E
Last Name:AMBORSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3725 N BUFFALO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1853
Mailing Address - Country:US
Mailing Address - Phone:716-662-2300
Mailing Address - Fax:716-662-2057
Practice Address - Street 1:3725 N BUFFALO ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1853
Practice Address - Country:US
Practice Address - Phone:716-662-2300
Practice Address - Fax:716-662-2057
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013917-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02772021Medicaid
NY02772021Medicaid