Provider Demographics
NPI:1265473987
Name:POIGNARD, EUGENIE M (PT DPT)
Entity Type:Individual
Prefix:
First Name:EUGENIE
Middle Name:M
Last Name:POIGNARD
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 WINCH ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750
Mailing Address - Country:US
Mailing Address - Phone:716-488-2322
Mailing Address - Fax:716-488-2574
Practice Address - Street 1:15 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-488-2522
Practice Address - Fax:716-488-2574
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0270671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0948Medicare PIN