MEDICARE: MISS JAMIE MARIE MARFURT PA-C

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	363A00000X	Physician Assistant	022337	NY

General Provider Information

NPI Number	:	1265919369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAMIE MARIE MARFURT PA-C

Provider Business Mailing Address
First Line	:	180 PARK CLUB LN STE 100
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5258
Country	:	US
Telephone Number	:	716-632-7465
Fax Number	:	716-608-6022

Provider Business Practice Location Address
First Line	:	180 PARK CLUB LN STE 100
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5258
Country	:	US
Telephone Number	:	716-632-7465
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	04/22/2025

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