Individual
JUNE MARIE TELAAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15 MELROY AVE, LACKAWANNA, NY 14218-1626
(716) 549-4724
(716) 821-0568
Mailing address
1344 MCKINLEY PKWY, LACKAWANNA, NY 14218-1643
(716) 649-0887
(716) 646-4611
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F331367
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026501304
UNIVERA
NY
01
—
000560258006
BLUE CROSS BLUE SHIELD
NY
05
—
02074257
—
NY
01
—
9511891
IHA
—
Enumeration date
06/14/2006
Last updated
10/26/2009
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