MEDICARE: MS. DEBORAH ANN MACIOLEK P.A.

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	363AS0400X	Surgical Physician Assistant	005245	NY

General Provider Information

NPI Number	:	1639154818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH ANN MACIOLEK P.A.

Provider Business Mailing Address
First Line	:	422 EVERGREEN DR
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-5536
Country	:	US
Telephone Number	:	716-862-6063
Fax Number	:	716-862-8600

Provider Business Practice Location Address
First Line	:	3495 BAILEY AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-1129
Country	:	US
Telephone Number	:	716-862-6063
Fax Number	:	716-862-8600

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	07/08/2007

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