Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP002723 | DE |
NPI | 1366405979 |
---|---|
Provider Name | Mr. Mark Zuchlewski |
First Address | Clarence, NY 14031-1704 |
Second Address | Clarence, NY 14031-1704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 10/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02670313 | (05) | NY |