Provider Demographics
NPI:1831329721
Name:TRZEPACZ, DONALD EDGAR JR (IDMT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:EDGAR
Last Name:TRZEPACZ
Suffix:JR
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 BLEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-6003
Mailing Address - Country:US
Mailing Address - Phone:716-863-4774
Mailing Address - Fax:
Practice Address - Street 1:9905 BLEWETT AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-6003
Practice Address - Country:US
Practice Address - Phone:716-863-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians