Healthcare Provider Details

I. General information

NPI: 1407004005
Provider Name (Legal Business Name): ELAINE MILCZARSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HUNT AVE
HAMBURG NY
14075-5142
US

IV. Provider business mailing address

145 HUNT AVE
HAMBURG NY
14075-5142
US

V. Phone/Fax

Practice location:
  • Phone: 716-481-6238
  • Fax:
Mailing address:
  • Phone: 716-481-6238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number395802-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: