Individual
DR. JAIRUS TESORERO IBABAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21 PORTER AVE, JAMESTOWN, NY 14701-6247
(716) 664-1909
(716) 664-2214
Mailing address
3041 ORCHARD PARK RD STE C, ORCHARD PARK, NY 14127-1238
(716) 674-3104
(716) 674-0666
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
193284
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005244934
BLUE CROSS BLUE SHIELD
NY
05
—
01830340
—
NY
01
—
0191329
INDEPENDENT HEALTH
NY
01
—
10352702
UNIVERA
NY
01
—
1294660001
DME
NY
01
—
714714
MVP
NY
01
—
7200341
GHI
NY
01
—
830006548
RAILROAD MEDICARE
NY
Enumeration date
05/24/2005
Last updated
03/29/2022
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