Provider Demographics
NPI:1922239086
Name:CZTERNASTEK, RANDY J (NP)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:J
Last Name:CZTERNASTEK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5606
Mailing Address - Country:US
Mailing Address - Phone:315-404-7157
Mailing Address - Fax:
Practice Address - Street 1:2 ELLINWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1102
Practice Address - Country:US
Practice Address - Phone:315-507-5081
Practice Address - Fax:315-738-1663
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335950-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily