Basic Information
| Provider Information | |||||||||
| NPI: | 1164715793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRYSZAK | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | RUGGERIO | ||||||||
| OtherFirstName: | AMY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1526 WALDEN AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254985 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 463 WILLIAM ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142041811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168930062 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2011 | ||||||||
| LastUpdateDate: | 10/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 082393-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.