Provider Demographics
NPI:1417939802
Name:SIEDLECKI, ANDREW JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:SIEDLECKI
Suffix:
Gender:M
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:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068
Mailing Address - Country:US
Mailing Address - Phone:716-634-8500
Mailing Address - Fax:716-634-8228
Practice Address - Street 1:170 MAPLE ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-634-8500
Practice Address - Fax:716-634-8228
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1780428207W00000X
NY178042-8207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01558621Medicaid
NYE35917Medicare UPIN
NYRA4926Medicare PIN