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NPI Code Detail

MEDICARE: CARRIE J FIDURKO

MEDICARE: CARRIE J FIDURKO
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1982807376
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE J FIDURKO
Provider Business Mailing Address
First Line : 21 CRESCENT ST
Second Line :
City : SALAMANCA
State : NY
Zip : 14779-1603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 203 LAURENS ST
Second Line :
City : OLEAN
State : NY
Zip : 14760-2511
Country : US
Telephone Number : 716-373-8080
Fax Number : 716-373-8150
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2007
Last Update Date : 07/08/2007

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