Provider Demographics
NPI:1164539391
Name:MAZURCZAK, MATTHEW (RPA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MAZURCZAK
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CORPORATE PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1200
Mailing Address - Country:US
Mailing Address - Phone:716-839-5858
Mailing Address - Fax:
Practice Address - Street 1:100 CORPORATE PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1200
Practice Address - Country:US
Practice Address - Phone:716-839-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant