Healthcare Provider Details

I. General information

NPI: 1326231291
Provider Name (Legal Business Name): CHURCHVILLE-CHILI FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BUFFALO RD BOX 505
NORTH CHILI NY
14514-1256
US

IV. Provider business mailing address

PO BOX 505
N. CHILI NY
14514
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-5995
  • Fax: 585-594-5425
Mailing address:
  • Phone: 585-594-5995
  • Fax: 585-594-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number174814
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number174814
License Number StateNY

VIII. Authorized Official

Name: DR. HENRY MIKOLAJ PASZKO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 585-594-5994