Basic Information
| Provider Information | |||||||||
| NPI: | 1659378180 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROTZER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3085 HARLEM RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142252591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445600 | ||||||||
| FaxNumber: | 7168445750 | ||||||||
| Practice Location | |||||||||
| Address1: | 3085 HARLEM RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142252591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445600 | ||||||||
| FaxNumber: | 7168445050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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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 | 363A00000X | 009998 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 161511795 | 01 | NY | NOVA | OTHER | 9512546 | 01 | NY | IHA | OTHER | 02555686 | 05 | NY | MEDICAID | 000570484001 | 01 | NY | BCBS OF WNY | OTHER | P00149417 | 01 | NY | RR MEDICARE | OTHER | 148338FZ | 01 | NY | PREFERRED CARE | OTHER |