Provider Demographics
NPI:1417941733
Name:JAREMKO, WILLIAM MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:JAREMKO
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 1:2646 W STATE ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1866
Mailing Address - Country:US
Mailing Address - Phone:716-373-8870
Mailing Address - Fax:716-373-8871
Practice Address - Street 1:2646 W STATE ST
Practice Address - Street 2:SUITE 405
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1866
Practice Address - Country:US
Practice Address - Phone:716-373-8870
Practice Address - Fax:716-373-8871
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020525401OtherUNIVERA
NY040426004117OtherFIDELLIS
PA01242516Medicaid
NY000511127003OtherBLUE CROSS BLUE SHIELD
NY01257047Medicaid
NY0307453OtherINDEPENDENT HEALTH
NY2200475OtherGHI
PA676204OtherBLUE CROSS BLUE SHIELD
NY040426004117OtherFIDELLIS
NYE91119Medicare UPIN