Provider Demographics
NPI:1205180437
Name:BIELEC, TONI M (PA)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:M
Last Name:BIELEC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:MARIE
Other - Last Name:MUTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3041 ORCHARD PARK RD
Mailing Address - Street 2:STE C
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1238
Mailing Address - Country:US
Mailing Address - Phone:716-674-3104
Mailing Address - Fax:716-671-0666
Practice Address - Street 1:6000 BROCKTON DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9273
Practice Address - Country:US
Practice Address - Phone:716-845-3400
Practice Address - Fax:716-438-1430
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016030-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03814106Medicaid