Provider Demographics
NPI:1497144513
Name:PANZARELLA, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:PANZARELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 N END AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1616
Mailing Address - Country:US
Mailing Address - Phone:716-626-2222
Mailing Address - Fax:716-626-2220
Practice Address - Street 1:8205 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6054
Practice Address - Country:US
Practice Address - Phone:716-626-2222
Practice Address - Fax:716-626-2220
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator