Basic Information
| Provider Information | |||||||||
| NPI: | 1649789868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEREDIUK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MYCHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 WEHRLE DR STE 7 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169327525 | ||||||||
| FaxNumber: | 7166309200 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 COMMUNITY DR | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142252523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165055630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 042126-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 042126-1 | 01 | NY | NYS PT LICENSE | OTHER |