Provider Demographics
NPI:1245400126
Name:PATRONIK, SUSAN M (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PATRONIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 S BENZING RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1705
Mailing Address - Country:US
Mailing Address - Phone:716-662-5357
Mailing Address - Fax:716-662-2774
Practice Address - Street 1:3670 S BENZING RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1705
Practice Address - Country:US
Practice Address - Phone:716-662-5357
Practice Address - Fax:716-662-2774
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2015-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053342363A00000X
NC001003668363AM0700X
NY017506-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00028380301OtherUNIVERA
NC8103048Medicaid
NCNCB213GMedicare PIN
NCNCB213AMedicare PIN
NCNCB213HMedicare PIN
NCNCB213EMedicare PIN
NC8103048Medicaid
NCNCB213BMedicare PIN
PA122879E7CMedicare PIN
NCNCB213CMedicare PIN
NCNCB213FMedicare PIN