Provider Demographics
NPI:1275593303
Name:PRZYSTAL, JANINA (MD)
Entity Type:Individual
Prefix:
First Name:JANINA
Middle Name:
Last Name:PRZYSTAL
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 1:604 ALT BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2450
Mailing Address - Country:US
Mailing Address - Phone:716-773-2059
Mailing Address - Fax:
Practice Address - Street 1:2605 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4018
Practice Address - Country:US
Practice Address - Phone:716-891-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126167207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000507440001OtherBLUE CROSS
NY040426001462OtherFIDELIS
NY00020067903OtherUNIVERA
NY2009997OtherINDEPENDENT HEALTH
4284OtherGHI
NY00691290Medicaid
4284OtherGHI
NY2009997OtherINDEPENDENT HEALTH