Provider Demographics
NPI:1073507091
Name:PIETRASZEK, SUSANNE (FNP)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:PIETRASZEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CAYUGA RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1942
Mailing Address - Country:US
Mailing Address - Phone:716-204-9711
Mailing Address - Fax:716-204-9717
Practice Address - Street 1:132 CAYUGA RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1942
Practice Address - Country:US
Practice Address - Phone:716-204-9711
Practice Address - Fax:716-204-9717
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02076997Medicaid
NY02076997Medicaid