Provider Demographics
NPI:1124337365
Name:LEMANKIEWICZ, COLLEEN M (PA-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:LEMANKIEWICZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1493
Mailing Address - Country:US
Mailing Address - Phone:716-688-6029
Mailing Address - Fax:716-961-9402
Practice Address - Street 1:300 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1802
Practice Address - Country:US
Practice Address - Phone:716-961-9400
Practice Address - Fax:716-961-9402
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014361363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400028749Medicare PIN