Individual
KELLY PASIECZNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
325 ESSJAY RD, WILLIAMSVILLE, NY 14221-8243
(716) 630-1102
(716) 633-6507
Mailing address
6255 SHERIDAN DR, SUITE 304, WILLIAMSVILLE, NY 14221-4836
(716) 857-8666
(716) 630-1054
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
013964
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000506570003
BLUE CROSS BLUE SHIELD
NY
01
—
040426001454
FIDELIS
—
01
—
1301314
INDEPENDENT HEALTH
—
01
—
16-1166492
EMPIRE
NY
01
—
16-1166492
GHI
—
01
—
441242008
RMC
NY
01
—
CPS/120905-5
COMPENSATION
NY
Enumeration date
03/05/2010
Last updated
10/08/2012
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