Jacqueline Czwojdak, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

020282-1 Issued in NY

Practice address

88 E Tioga Ave Ste 102
Corning, NY 14830-2882

Phone

(607) 684-6115

Fax

(607) 684-6120

NPI assigned

Oct 25, 2016

Last updated

Sep 3, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jczwojdak@smithallergy.medentdirect.com

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

• Southern Tier Community Health Center Network, Inc.

  dba Universal Primary Care

  • Federally Qualified Health Center (FQHC)
  • Olean, NY
  • NPI 1184654477
  Medicare reassignment NPD
• Emergency Physician Services of New York, P.C.

  • Emergency Medicine Physician
  • Poughkeepsie, NY
  • NPI 1093759847
  Medicare reassignment
• Smith Allergy and Asthma of Central New York PLLC

  • Allergy & Immunology Physician
  • Corning, NY
  • NPI 1700165990
  Medicare reassignment
• Southern Tier Community Health Center Network, Inc.

  dba Universal Primary Care

  • Dental Clinic/Center
  • Bradford, PA
  • NPI 1962399394
  NPD

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

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1285186320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N UNION ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147602736",
            "telephone_number": "716-375-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 E TIOGA AVE STE 102",
            "city": "CORNING",
            "state": "NY",
            "postal_code": "148302882",
            "telephone_number": "607-684-6115",
            "fax_number": "607-684-6120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3773 Luker Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Cortland",
            "state": "NY",
            "postal_code": "130459398",
            "country_code": "US",
            "telephone_number": "607-662-4059",
            "fax_number": "607-662-4241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2430 N Triphammer Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Ithaca",
            "state": "NY",
            "postal_code": "148501160",
            "country_code": "US",
            "telephone_number": "607-379-6072",
            "fax_number": "607-379-6075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CZWOJDAK",
        "first_name": "JACQUELINE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-25",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020282",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "020282-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal City Apothecary LLC
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• Crystal Waters Licensed Clinical Social Work, PLLC
• Kevin Patrick Cunningham, MD
• Julie D Curran, O.D.
• Darci Davis, LCSW
• Jennifer Decapria Close, LCSW-R
• Angie L. Degraff-Dacey, LPN
• Hannah Delfavero
• Cynthia Demuth, FNP

• Medical Physician Assistant in Corning, NY
• Providers in Corning, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.