Provider Demographics
NPI:1487684163
Name:ZWIJACZ, LARA MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:MICHELE
Last Name:ZWIJACZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:MICHELE
Other - Last Name:HOSHKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 OLD PLANK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3107
Mailing Address - Country:US
Mailing Address - Phone:518-371-0777
Mailing Address - Fax:518-371-0366
Practice Address - Street 1:211 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1003
Practice Address - Country:US
Practice Address - Phone:518-587-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006162363A00000X
SCPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCS729927511Medicare ID - Type Unspecified
S72992Medicare UPIN