Basic Information
| Provider Information | |||||||||
| NPI: | 1508271214 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SIEJKA | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3925 SHERIDAN DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142261738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162506492 | ||||||||
| FaxNumber: | 7162506522 | ||||||||
| Practice Location | |||||||||
| Address1: | 2625 HARLEM RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168930333 | ||||||||
| FaxNumber: | 7168933038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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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 | 363AS0400X | 017618 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.