Basic Information
| Provider Information | |||||||||
| NPI: | 1316288400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KORNOWICZ | ||||||||
| FirstName: | JEANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 WELLINGTON RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142162427 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4242 RIDGE LEA RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142261051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168192400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2013 | ||||||||
| LastUpdateDate: | 03/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | Y | Other Service Providers | Contractor |
No ID Information.