Basic Information
| Provider Information | |||||||||
| NPI: | 1811391584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZZARELLO | ||||||||
| FirstName: | MARK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3176 ABBOTT RD | ||||||||
| Address2: | BUILDING A, SUITE 500 | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168222177 | ||||||||
| FaxNumber: | 7168228165 | ||||||||
| Practice Location | |||||||||
| Address1: | 3176 ABBOTT RD | ||||||||
| Address2: | BUILDING A, SUITE 500 | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168222177 | ||||||||
| FaxNumber: | 7168228165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2014 | ||||||||
| LastUpdateDate: | 10/09/2014 | ||||||||
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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 | 163W00000X | 22 500058 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.