Basic Information
| Provider Information | |||||||||
| NPI: | 1003007782 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMERKA | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 ORCHARD PARK RD | ||||||||
| Address2: | SUITE A105 | ||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166776000 | ||||||||
| FaxNumber: | 7166776006 | ||||||||
| Practice Location | |||||||||
| Address1: | 4050 HARLEM RD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142264711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168031504 | ||||||||
| FaxNumber: | 7168031508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 06/21/2010 | ||||||||
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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 | 011934 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.