Provider Demographics
NPI:1568887933
Name:LAJUDICE, CHRISTOPHER ZACHARY (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ZACHARY
Last Name:LAJUDICE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:ZACHARY
Other - Last Name:LICKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:325 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8243
Practice Address - Country:US
Practice Address - Phone:716-630-2600
Practice Address - Fax:716-626-1858
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NY017403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03809478Medicaid
NYP01620166OtherMEDICARE RR
NYJ400189787/GRP70008AMedicare PIN
NY03809478Medicaid