1003222779 NPI number — MRS. SARAH JOYCE MACIEJEWSKI MSED

Table of content: MRS. SARAH JOYCE MACIEJEWSKI MSED (NPI 1003222779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003222779 NPI number — MRS. SARAH JOYCE MACIEJEWSKI MSED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACIEJEWSKI
Provider First Name:
SARAH
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUDERMAN
Provider Other First Name:
SARAH
Provider Other Middle Name:
JOYCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003222779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8128 N PEMBROKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATAVIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14020-9445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-505-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4635 UNION ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-505-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2014

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: 174400000X , with the licence number:  160312071 , 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)





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