Healthcare Provider Details

I. General information

NPI: 1306850672
Provider Name (Legal Business Name): COLLEEN A ANGIELCZYK PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 SENECA ST
EAST AURORA NY
14052-9407
US

IV. Provider business mailing address

7531 SENECA ST
EAST AURORA NY
14052-9407
US

V. Phone/Fax

Practice location:
  • Phone: 716-655-5019
  • Fax: 716-655-1567
Mailing address:
  • Phone: 716-655-5019
  • Fax: 716-655-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001747-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: