Basic Information
| Provider Information | |||||||||
| NPI: | 1669094140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLULOW | ||||||||
| FirstName: | ABBY | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 142 N FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | COCHRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163149718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147957581 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2625 HARLEM RD | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168930333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2020 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 024945 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 024945 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.