MEDICARE: CASSI CHUDZIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1043712029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSI CHUDZIK

Provider Business Mailing Address
First Line	:	4752 LAKE SHORE RD
Second Line	:
City	:	HAMBURG
State	:	NY
Zip	:	14075-3309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4752 LAKE SHORE RD
Second Line	:
City	:	HAMBURG
State	:	NY
Zip	:	14075-3309
Country	:	US
Telephone Number	:	716-574-8815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	03/06/2018

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Directions to “ CASSI CHUDZIK ” Practice Location

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