MEDICARE: MARY C TRENKLE LMT

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	174400000X	Specialist	017586	NY

General Provider Information

NPI Number	:	1972791507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C TRENKLE LMT

Provider Business Mailing Address
First Line	:	372 FRONTIER AVE
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2416
Country	:	US
Telephone Number	:	716-868-7053
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 GRAND ISLAND BLVD
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-2131
Country	:	US
Telephone Number	:	716-868-7053
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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