Individual provider Active NPI

Lynn M Kordasiewicz, NURSE PRACTITIONER

  • Nurse Practitioner
  • Cheektowaga, NY
National Provider Identifier
1124213780
Registry record updated Sep 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
304627 Issued in NY
Practice address
2355 Union Rd
Cheektowaga, NY 14227-2234
Phone
(716) 857-8603
Fax
(716) 856-5844
NPI assigned
Sep 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 304627 NY Primary

Addresses

Primary practice location

2355 Union Rd
Cheektowaga, NY 14227-2234

Mailing address

6255 Sheridan Dr
Suite 304
Williamsville, NY 14221-4836
Phone (716) 857-8666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071214000251 NY Practitioner - Nurse Practitioner 4789774712 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
304627NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Erie County Medical Center Corporation CurrentSince Aug 1, 2010 Accepting new patients
Erie County Medical Center Corporation CurrentSince Aug 1, 2010 Accepting new patients

Locations

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189123200000",
    "number": "1124213780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6255 SHERIDAN DR",
            "address_2": "SUITE 304",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142214836",
            "telephone_number": "716-857-8666",
            "fax_number": "716-857-8944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 UNION RD",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142272234",
            "telephone_number": "716-857-8603",
            "fax_number": "716-856-5844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDASIEWICZ",
        "first_name": "LYNN",
        "middle_name": "M",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-07",
        "last_updated": "2007-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "304627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheektowaga, NY

Sources for this page

Verify at the official NPI Registry.