MEDICARE: GREGORY T TYMCHAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	203797	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00025517004	OTHER		UNIVERA
2	000524750011	OTHER		BLUE SHIELD OF WESTERN NY
3	1608981	OTHER		INDEPENDENT HEALTH
4	2037976CR	OTHER	NY	WORKERS COMPENSATION

General Provider Information

NPI Number	:	1710961149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY T TYMCHAK

Provider Business Mailing Address
First Line	:	100 COLLEGE PKWY
Second Line	:	SUITE 180
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-6800
Country	:	US
Telephone Number	:	716-636-1902
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 COLLEGE PKWY
Second Line	:	SUITE 180
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-6800
Country	:	US
Telephone Number	:	716-636-1902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/25/2012

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Directions to “ GREGORY T TYMCHAK ” Practice Location

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