Healthcare Provider Details

I. General information

NPI: 1619151560
Provider Name (Legal Business Name): PEGGY S URBANCZYK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MAIN RD STE 2
CORFU NY
14036-9753
US

IV. Provider business mailing address

860 MAIN RD STE 2
CORFU NY
14036-9753
US

V. Phone/Fax

Practice location:
  • Phone: 585-599-6446
  • Fax: 585-344-3047
Mailing address:
  • Phone: 585-599-6446
  • Fax: 585-344-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF30962501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: