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NPI Code Detail

MEDICARE: TONJA LYNN BANGEL

MEDICARE: TONJA LYNN BANGEL
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCRPA-5796NY

General Provider Information

NPI Number : 1558209668
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONJA LYNN BANGEL
Provider Business Mailing Address
First Line : 77 BROADWAY ST
Second Line :
City : BUFFALO
State : NY
Zip : 14203-1642
Country : US
Telephone Number : 716-834-6401
Fax Number :
Provider Business Practice Location Address
First Line : 77 BROADWAY ST
Second Line :
City : BUFFALO
State : NY
Zip : 14203-1642
Country : US
Telephone Number : 716-834-6401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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