Provider Demographics
NPI:1124328307
Name:ACACIA FAMILY HEALTH NP PLLC
Entity type:Organization
Organization Name:ACACIA FAMILY HEALTH NP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:OSTOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-514-9355
Mailing Address - Street 1:702 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5371
Mailing Address - Country:US
Mailing Address - Phone:716-514-9355
Mailing Address - Fax:
Practice Address - Street 1:702 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5371
Practice Address - Country:US
Practice Address - Phone:716-514-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3316771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0331797Medicaid
NY0331797Medicaid