1700156072 NPI number — EILEEN K. KOSIERACKI, D.O.,P.C.

Table of content: (NPI 1700156072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700156072 NPI number — EILEEN K. KOSIERACKI, D.O.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EILEEN K. KOSIERACKI, D.O.,P.C.
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:
1700156072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3916 LONG BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14411-9310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-589-6247
Provider Business Mailing Address Fax Number:
585-589-6351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3916 LONG BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14411-9310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-589-6247
Provider Business Practice Location Address Fax Number:
585-589-6351
Provider Enumeration Date:
01/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KOSIERACKI
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
KATHERINE
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
585-589-6247

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  184108 , 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: 0103805 . This is a "INDEPENENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5745356 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MD134P . This is a "MVP/PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000010093901 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010184108 . This is a "EXCELLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CC7209 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01248562 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900220 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000511199002 . This is a "BLUE CROSS BLUE SHIELD OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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