Basic Information
| Provider Information | |||||||||
| NPI: | 1043275704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CZESAK-PEZZINO | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6301 TRANSIT RD | ||||||||
| Address2: | |||||||||
| City: | DEPEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140431051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166840400 | ||||||||
| FaxNumber: | 7166837028 | ||||||||
| Practice Location | |||||||||
| Address1: | 12395 OLEAN RD | ||||||||
| Address2: | |||||||||
| City: | CHAFFEE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164965550 | ||||||||
| FaxNumber: | 7164965328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 01585217 | 05 | NY | MEDICAID | 6602448 | 01 | NY | GHI | OTHER | 000623656002 | 01 | NY | BCBS | OTHER | 040426001136 | 01 | NY | FIDELIS | OTHER | 9307267 | 01 | NY | IHA | OTHER | 00011174501 | 01 | NY | UNIVERA | OTHER |