Healthcare Provider Details

I. General information

NPI: 1093404972
Provider Name (Legal Business Name): ZACHARY W MINER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 04/21/2025
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 BROCKTON DR
LOCKPORT NY
14094-9273
US

IV. Provider business mailing address

3041 ORCHARD PARK RD STE C
ORCHARD PARK NY
14127-1238
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-3400
  • Fax: 716-438-1430
Mailing address:
  • Phone: 716-674-3104
  • Fax: 716-674-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number030004
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: