Basic Information
| Provider Information | |||||||||
| NPI: | 1679560510 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SZULEWSKI | ||||||||
| FirstName: | CELESTINE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922832 | ||||||||
| FaxNumber: | 7165924452 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141411244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165922832 | ||||||||
| FaxNumber: | 7165924452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 000761 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 00021055501 | 01 | NY | UNIVERA | OTHER | 9511767 | 01 | NY | IHA | OTHER | 000570138006 | 01 | NY | BC/BS | OTHER | 01969479 | 05 | NY | MEDICAID |