Provider Demographics
NPI:1659378180
Name:CROTZER, BRIAN C (PA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:CROTZER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 HARLEM RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5600
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:3085 HARLEM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2591
Practice Address - Country:US
Practice Address - Phone:716-844-5600
Practice Address - Fax:716-844-5050
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161511795OtherNOVA
NY9512546OtherIHA
NY02555686Medicaid
NY000570484001OtherBCBS OF WNY
NYP00149417OtherRR MEDICARE
NY148338FZOtherPREFERRED CARE
NYQ21283Medicare UPIN
NYPA0403Medicare ID - Type Unspecified