Basic Information
| Provider Information | |||||||||
| NPI: | 1619151560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URBANCZYK | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 MAIN RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | CORFU | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140369753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855996446 | ||||||||
| FaxNumber: | 5853443047 | ||||||||
| Practice Location | |||||||||
| Address1: | 860 MAIN RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | CORFU | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140369753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855996446 | ||||||||
| FaxNumber: | 5853443047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F30962501 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.