Provider Demographics
NPI:1770627622
Name:WHEATFIELD FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:WHEATFIELD FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SZYMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:716-693-5463
Mailing Address - Street 1:3799 COMMERCE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2024
Mailing Address - Country:US
Mailing Address - Phone:716-693-5463
Mailing Address - Fax:716-693-6370
Practice Address - Street 1:3799 COMMERCE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2024
Practice Address - Country:US
Practice Address - Phone:716-693-5463
Practice Address - Fax:716-693-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02396665Medicaid
NYAA1679Medicare ID - Type Unspecified
NYH84165Medicare UPIN