Provider Demographics
NPI:1851829808
Name:BIERSBACH, HALLEY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:HALLEY
Middle Name:ANNE
Last Name:BIERSBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HALLEY
Other - Middle Name:ANNE
Other - Last Name:KREMINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:462 GRIDER STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:3900 N BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1842
Practice Address - Country:US
Practice Address - Phone:716-656-4852
Practice Address - Fax:716-817-1779
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY020860363AS0400X
NY020860-01363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04794978Medicaid