1356664627 NPI number — MICHAEL I. HANZLY DPM PC

Table of content: (NPI 1356664627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356664627 NPI number — MICHAEL I. HANZLY DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL I. HANZLY DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1356664627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2267 SENECA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14210-2517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-823-0049
Provider Business Mailing Address Fax Number:
716-823-3744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2267 SENECA ST
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:
14210-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-823-0049
Provider Business Practice Location Address Fax Number:
716-823-3744
Provider Enumeration Date:
03/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HANZLY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-823-0049

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  2793 , 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: 00010251601 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: U00029 . This is a "UPIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00507505005 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00669750 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8907425 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com