Provider Demographics
NPI:1154310407
Name:GAZDAK, GINA M (CRNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:GAZDAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:GREENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:14742-0400
Mailing Address - Country:US
Mailing Address - Phone:716-488-5000
Mailing Address - Fax:
Practice Address - Street 1:3023 ROUTE 60
Practice Address - Street 2:
Practice Address - City:GREENHURST
Practice Address - State:NY
Practice Address - Zip Code:14742-0400
Practice Address - Country:US
Practice Address - Phone:716-488-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305097-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q11205Medicare UPIN
077437Medicare ID - Type Unspecified