1962457747 NPI number — MRS. JANEL L. PODSIADLO FNP-BC

Table of content: MRS. JANEL L. PODSIADLO FNP-BC (NPI 1962457747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962457747 NPI number — MRS. JANEL L. PODSIADLO FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PODSIADLO
Provider First Name:
JANEL
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MROZ
Provider Other First Name:
JANEL
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962457747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 LOSSON RD STE 105
Provider Second Line Business Mailing Address:
PARKVIEW PRIMARY CARE PHYSICIANS, PLLC
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14227-2379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-558-7727
Provider Business Mailing Address Fax Number:
716-558-7720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 LOSSON ROAD - SUITE 105
Provider Second Line Business Practice Location Address:
PARKVIEW PRIMARY CARE PHYSICIANS, PLLC
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-558-7727
Provider Business Practice Location Address Fax Number:
716-558-7720
Provider Enumeration Date:
05/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  F331783-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00026799701 . This is a "EXCELLUS UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9511803 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 005603072 . This is a "HEALTH NOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01807258 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".