Provider Demographics
NPI:1710476692
Name:WACHOWIAK, ARIEL MARIE
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:MARIE
Last Name:WACHOWIAK
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 1:210 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1928
Mailing Address - Country:US
Mailing Address - Phone:716-427-4359
Mailing Address - Fax:
Practice Address - Street 1:1832 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1119
Practice Address - Country:US
Practice Address - Phone:716-427-4359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005765171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty