Healthcare Provider Details

I. General information

NPI: 1205073764
Provider Name (Legal Business Name): KAREN KAZIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 SHERIDAN DR
TONAWANDA NY
14150-9407
US

IV. Provider business mailing address

29 JEANMOOR RD
BUFFALO NY
14228-3036
US

V. Phone/Fax

Practice location:
  • Phone: 716-838-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: