1437210283 NPI number — MYRON MYCHAJLUK CASAC

Table of content: MYRON MYCHAJLUK CASAC (NPI 1437210283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437210283 NPI number — MYRON MYCHAJLUK CASAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYCHAJLUK
Provider First Name:
MYRON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CASAC
Provider Gender Code:
M

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:
1437210283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 THORN AVE
Provider Second Line Business Mailing Address:
SPECTRUM HUMAN SERVICES
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-662-2040
Provider Business Mailing Address Fax Number:
716-662-0019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 SENECA ST
Provider Second Line Business Practice Location Address:
SOUTH BUFFALO COUNSELING CENTER
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14210-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-828-0560
Provider Business Practice Location Address Fax Number:
716-828-1522
Provider Enumeration Date:
12/13/2006

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: 101YA0400X , with the licence number:  8568 , 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)