MEDICARE: MRS. CHRISTINE J PIECZONKA RN

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	251300000X	Local Education Agency (LEA)	425640	NY

General Provider Information

NPI Number	:	1871861732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE J PIECZONKA RN

Provider Business Mailing Address
First Line	:	4737 LAKE SHORE RD
Second Line	:	C/O ST MARY OF THE LAKE SCHOOL,
City	:	HAMBURG
State	:	NY
Zip	:	14075-3308
Country	:	US
Telephone Number	:	716-627-7700
Fax Number	:	716-627-1255

Provider Business Practice Location Address
First Line	:	4737 LAKE SHORE RD
Second Line	:	C/O ST MARY OF THE LAKE SCHOOL,
City	:	HAMBURG
State	:	NY
Zip	:	14075-3308
Country	:	US
Telephone Number	:	716-627-7700
Fax Number	:	716-627-1255

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

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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