Healthcare Provider Details

I. General information

NPI: 1215508213
Provider Name (Legal Business Name): AARON K MRUK FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 NIAGARA ST BLDG 2
BUFFALO NY
14201-1108
US

IV. Provider business mailing address

732 PASADENA AVE
NIAGARA FALLS NY
14304-3542
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-0366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347814
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: