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NPI Code Detail

MEDICARE: ANDREA KLIMTZAK PA

MEDICARE: ANDREA KLIMTZAK PA
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
1363A00000XPhysician Assistant010679NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100027264901OTHERNYUNIVERA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3172119BFOTHERNYPREFERRED CARE
49512871OTHERNYIHA
5000570550001OTHERNYBC/BS
6051031000028OTHERNYFIDELIS

General Provider Information

NPI Number : 1902874688
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA KLIMTZAK PA
Provider Business Mailing Address
First Line : 112 OLEAN ST
Second Line : SUITE 220
City : EAST AURORA
State : NY
Zip : 14052-2540
Country : US
Telephone Number : 716-805-1072
Fax Number : 716-805-1073
Provider Business Practice Location Address
First Line : 112 OLEAN ST
Second Line : SUITE 220
City : EAST AURORA
State : NY
Zip : 14052-2540
Country : US
Telephone Number : 716-805-1072
Fax Number : 716-805-1073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 03/11/2011

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Directions to “ ANDREA KLIMTZAK PA” Practice Location

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