Provider Demographics
NPI:1366405979
Name:ZUCHLEWSKI, MARK (CP, FAAOP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:ZUCHLEWSKI
Suffix:
Gender:M
Credentials:CP, FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10654 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1704
Mailing Address - Country:US
Mailing Address - Phone:716-759-9111
Mailing Address - Fax:716-759-9112
Practice Address - Street 1:10654 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1704
Practice Address - Country:US
Practice Address - Phone:716-759-9111
Practice Address - Fax:716-759-9112
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECP002723224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02670313Medicaid
NY5397880001Medicare NSC