Provider Demographics
NPI:1902070634
Name:DZIADOSZ, JENNIFER ANNE (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:DZIADOSZ
Suffix:
Gender:F
Credentials:ANP-BC
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Mailing Address - Street 1:701 SENECA ST
Mailing Address - Street 2:SUITE 646
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-1351
Mailing Address - Country:US
Mailing Address - Phone:716-995-4450
Mailing Address - Fax:844-206-7424
Practice Address - Street 1:701 SENECA ST
Practice Address - Street 2:SUITE 646
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-1351
Practice Address - Country:US
Practice Address - Phone:716-995-4450
Practice Address - Fax:844-206-7424
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY304808363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400004164Medicare PIN