Basic Information
| Provider Information | |||||||||
| NPI: | 1699751990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGNATCHIK | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 ORCHARD PARK RD | ||||||||
| Address2: | SUITE A105 | ||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166776000 | ||||||||
| FaxNumber: | 7166776006 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 ORCHARD PARK RD | ||||||||
| Address2: | SUITE B103 | ||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166775005 | ||||||||
| FaxNumber: | 7167120160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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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 | 207T00000X | 1432671 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00010050501 | 01 | NY | UNIVERA HEALTHCARE | OTHER | 140005699 | 01 | RAILROAD MEDICARE | OTHER | 000511384002 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 00686833 | 05 | NY | MEDICAID | 0604042 | 01 | NY | INDEPENDENT HEALTH | OTHER |