Provider Demographics
NPI:1104572395
Name:SIERGIEJ PHYSICAL THERAPY
Entity type:Organization
Organization Name:SIERGIEJ PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERGIEJ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-444-2345
Mailing Address - Street 1:67 LE HAVRE DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2411
Mailing Address - Country:US
Mailing Address - Phone:716-444-2345
Mailing Address - Fax:
Practice Address - Street 1:167 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1989
Practice Address - Country:US
Practice Address - Phone:716-444-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy