Basic Information
| Provider Information | |||||||||
| NPI: | 1740265537 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CZAJKA | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | RPA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3085 HARLEM RD | ||||||||
| Address2: | STE 350 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142252591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445600 | ||||||||
| FaxNumber: | 7168445750 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 PARK CLUB LN | ||||||||
| Address2: | STE 100 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168399402 | ||||||||
| FaxNumber: | 7168393570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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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 | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 970007176 | 01 | RAILROAD MEDICARE | OTHER | 00026511001 | 01 | NY | UNIVERA HEALTHCARE | OTHER | 01412591 | 05 | NY | MEDICAID | 000570002005 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 9512079 | 01 | NY | INDEPENDENT HEALTH | OTHER |