Provider Demographics
NPI:1477529386
Name:KAZINSKI, EVELYN A (RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:A
Last Name:KAZINSKI
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1910
Mailing Address - Country:US
Mailing Address - Phone:716-874-4500
Mailing Address - Fax:716-874-8145
Practice Address - Street 1:2128 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1910
Practice Address - Country:US
Practice Address - Phone:716-874-4500
Practice Address - Fax:716-874-8145
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004656133V00000X
NY4422841133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6507343OtherENCOMPASS 65
8000002OtherGROUP HEALTH INS PPO CMP
9609415OtherCUSTOM COVERAGE
6507343OtherMEDISOURCE
NY01465154Medicaid
6507343OtherIHA ENCOMPASS
6507343OtherENCOMPASS PLUS
710000694OtherRAILROAD MEDICARE
6507343OtherENCOMPASS PLUS