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General NPI Number Information
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NPI Number | 1093404972
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Entity Type | Individual
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Provider Name | ZACHARY W MINER PA
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Gender | Male
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 6000 BROCKTON DR
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City | LOCKPORT
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State | NY
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Zip | 14094-9273
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Country | US
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Telephone | 716-845-3400
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Fax | 716-438-1430
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Provider Business Mailing Address
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Address Line | 3041 ORCHARD PARK RD STE C
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1238
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Country | US
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Telephone | 716-674-3104
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Fax | 716-674-0666
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 030004
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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