MEDICARE: SUSAN C RAJCZAK ANP

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	363LA2200X	Adult Health Nurse Practitioner	F302131	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000560315001	OTHER	NY	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	040426001782	OTHER	NY	FIDELIS
4	5711686	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1578563995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN C RAJCZAK ANP

Provider Business Mailing Address
First Line	:	550 ORCHARD PARK RD
Second Line	:	A103
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2646
Country	:	US
Telephone Number	:	716-677-5500
Fax Number	:	716-677-5008

Provider Business Practice Location Address
First Line	:	550 ORCHARD PARK RD
Second Line	:	A103
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2646
Country	:	US
Telephone Number	:	716-677-5500
Fax Number	:	716-677-5008

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/11/2007

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Directions to “ SUSAN C RAJCZAK ANP” Practice Location

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