Provider Demographics
NPI:1316492820
Name:KORZENIEWSKI, MELANIE ANNE WINSLOW
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE WINSLOW
Last Name:KORZENIEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7745 PROSPECT STATION RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-9628
Mailing Address - Country:US
Mailing Address - Phone:716-753-6810
Mailing Address - Fax:
Practice Address - Street 1:7745 PROSPECT STATION RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-9628
Practice Address - Country:US
Practice Address - Phone:716-753-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator