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1093404972 NPI number — ZACHARY W MINER PA

NPI Number: 1093404972
Health Care Provider/Practitioner: ZACHARY W MINER PA

Information about “1093404972” NPI (ZACHARY W MINER PA) exists in 1093404972 in HTML format HTML  |  1093404972 in plain Text format TXT  |  1093404972 in PDF (Portable Document Format) PDF  |  1093404972 in an XML format XML  formats.

NPI Number : 1093404972 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093404972",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MINER",
    "FirstName": "ZACHARY",
    "MiddleName": "W",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3041 ORCHARD PARK RD",
    "SecondLineMailingAddress": "STE C",
    "MailingAddressCityName": "ORCHARD PARK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14127-1238",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "716-674-3104",
    "MailingAddressFaxNumber": "716-674-0666",
    "FirstLinePracticeLocationAddress": "6000 BROCKTON DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOCKPORT",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14094-9273",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "716-845-3400",
    "PracticeLocationAddressFaxNumber": "716-438-1430",
    "EnumerationDate": "05/05/2023",
    "LastUpdateDate": "04/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "030004",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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