Provider Demographics
NPI:1811129315
Name:ZAKROCZEMSKI, DAMIAN DANIEL (RPA-C)
Entity type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:DANIEL
Last Name:ZAKROCZEMSKI
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:30 N UNION RD
Mailing Address - Street 2:STE 102
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-852-1977
Mailing Address - Fax:716-859-7388
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:SUITE B252
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-852-1977
Practice Address - Fax:716-859-7388
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2016-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY013286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03160010Medicaid
NYJ400007792Medicare UPIN