Healthcare Provider Details

I. General information

NPI: 1841719572
Provider Name (Legal Business Name): JULIA GAJEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GEORGE KARL BLVD
WILLIAMSVILLE NY
14221-7183
US

IV. Provider business mailing address

6630 YORKTOWN CIR
EAST AMHERST NY
14051-1588
US

V. Phone/Fax

Practice location:
  • Phone: 716-218-1050
  • Fax:
Mailing address:
  • Phone: 716-359-4942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number308232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: