Provider Demographics
NPI:1104466077
Name:ADAMCZAK, LOGAN JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:JAMES
Last Name:ADAMCZAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 EIGHT BELLES LN APT 2E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9874
Mailing Address - Country:US
Mailing Address - Phone:607-423-9560
Mailing Address - Fax:
Practice Address - Street 1:STRONG MEMORIAL HOSPITAL 601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24542363A00000X
NY024542-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant