Provider Demographics
NPI:1992072516
Name:GASIEWICZ, MARCY (LMT)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:
Last Name:GASIEWICZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:BUERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5444 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2749
Mailing Address - Country:US
Mailing Address - Phone:716-440-4699
Mailing Address - Fax:716-649-9965
Practice Address - Street 1:5444 CAMP RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2749
Practice Address - Country:US
Practice Address - Phone:716-440-4699
Practice Address - Fax:716-649-9965
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024329225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist