National Provider Identifier
Jairus Tesorero Ibabao, MD
Jairus Tesorero Ibabao, MD is listed in the NPPES registry with a primary specialty of Hematology & Oncology Physician in Jamestown, NY and a listed phone number of (716) 664-1909.
Profile Overview
- NPI
- 1568465458
- Provider Type
- Individual
- Primary Specialty
- Hematology & Oncology Physician
- Enumeration Date
- May 24, 2005
- Last Updated
- March 29, 2022
Practice Location
- 21 Porter Ave
- Jamestown, NY 14701-6247
Phone: (716) 664-1909
Mailing Address
- 3041 Orchard Park RD Ste C
- Orchard Park, NY 14127-1238
Specialties
- Hematology & Oncology Physician (207RH0003X)
Full Record
- NPI
- 1568465458
- Entity Type
- Individual
- Last Name
- Ibabao
- First Name
- Jairus
- Middle Name
- Tesorero
- Name Prefix
- Dr.
- Credential
- MD
- Mailing Street Address
- 3041 Orchard Park RD Ste C
- Mailing City
- Orchard Park
- Mailing State
- NY
- Mailing ZIP Code
- 14127-1238
- Mailing Country
- US
- Mailing Phone
- (716) 674-3104
- Mailing Fax
- (716) 674-0666
- Practice Street Address
- 21 Porter Ave
- Practice City
- Jamestown
- Practice State
- NY
- Practice ZIP Code
- 14701-6247
- Practice Country
- US
- Practice Phone
- (716) 664-1909
- Practice Fax
- (716) 664-2214
- Enumeration Date
- May 24, 2005
- Last Updated
- March 29, 2022
- Sex
- Male
- Sole Proprietor
- Yes
- Certification Date
- March 29, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Hematology & Oncology Physician (207RH0003X)
- Other Identifiers
- 714714 (NY, Mvp), 005244934 (NY, Blue Cross Blue Shield), 7200341 (NY, Ghi), 830006548 (NY, Railroad Medicare), 10352702 (NY, Univera), 0191329 (NY, Independent Health), 1294660001 (NY, Dme), 01830340 (NY)