Basic Information
| Provider Information | |||||||||
| NPI: | 1477529386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAZINSKI | ||||||||
| FirstName: | EVELYN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD CDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2128 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Practice Location | |||||||||
| Address1: | 2128 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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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 | 133V00000X | 004656 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133N00000X | 4422841 | NY | N | Dietary & Nutritional Service Providers | Nutritionist |
ID Information
| ID | Type | State | Issuer | Description | 6507343 | 01 | ENCOMPASS 65 | OTHER | 8000002 | 01 | GROUP HEALTH INS PPO CMP | OTHER | 9609415 | 01 | CUSTOM COVERAGE | OTHER | 6507343 | 01 | MEDISOURCE | OTHER | 01465154 | 05 | NY | MEDICAID | 6507343 | 01 | IHA ENCOMPASS | OTHER | 6507343 | 01 | ENCOMPASS PLUS | OTHER | 710000694 | 01 | RAILROAD MEDICARE | OTHER |