Provider Demographics
NPI:1881761864
Name:ORSZULAK, TODD M JR (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:ORSZULAK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1335
Mailing Address - Country:US
Mailing Address - Phone:716-236-7880
Mailing Address - Fax:716-236-7885
Practice Address - Street 1:4515 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1335
Practice Address - Country:US
Practice Address - Phone:716-236-7880
Practice Address - Fax:716-236-7885
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2166961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02273132Medicaid
H21701Medicare UPIN
CC1390Medicare ID - Type Unspecified
NYJ400003437Medicare PIN