=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811247661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYNAR JOSS LIM-ZOLCZER PMHNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2012
-----------------------------------------------------
Last Update Date | 04/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6495 TRANSIT RD STE 800
-----------------------------------------------------
City | EAST AMHERST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-418-8531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 DODGE RD
-----------------------------------------------------
City | GETZVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14068-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-831-2700
-----------------------------------------------------
Fax | 716-831-1818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 565722
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 401874
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------