Provider Demographics
NPI:1265466171
Name:WERCHINSKI, AMY L (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WERCHINSKI
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:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220
Mailing Address - Country:US
Mailing Address - Phone:315-701-5607
Mailing Address - Fax:315-701-5608
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:SUITE G-30
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5861
Practice Address - Fax:315-376-5864
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY011051363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03163013Medicaid
NY03163013Medicaid
NYJ400162338Medicare PIN
NYJ400009558Medicare PIN