1346308475 NPI number — CHERYL MARIE ZACHEWICZ ANP

Table of content: CHERYL MARIE ZACHEWICZ ANP (NPI 1346308475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346308475 NPI number — CHERYL MARIE ZACHEWICZ ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZACHEWICZ
Provider First Name:
CHERYL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346308475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7299 GARTMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-208-7829
Provider Business Mailing Address Fax Number:
716-208-7829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 LAKEFONT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14202-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-849-8750
Provider Business Practice Location Address Fax Number:
716-849-8757
Provider Enumeration Date:
12/04/2006

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: 363LA2200X , with the licence number:  303474 , 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)