Provider Demographics
NPI:1225145485
Name:PRAWAK-PASIEKA, ALEXSANDRA (MD)
Entity Type:Individual
Prefix:
First Name:ALEXSANDRA
Middle Name:
Last Name:PRAWAK-PASIEKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2822
Mailing Address - Country:US
Mailing Address - Phone:716-891-9444
Mailing Address - Fax:716-891-9445
Practice Address - Street 1:1320 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2822
Practice Address - Country:US
Practice Address - Phone:716-891-9444
Practice Address - Fax:716-891-9445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000506436001OtherBLUE CROSS OF WNY
NY00632384Medicaid
NY00010141101OtherUNIVERA
NY00632384Medicaid
NYP064361Medicare ID - Type Unspecified