Provider Demographics
NPI:1053755876
Name:HAMBURG NURSE PRACTITIONERS IN ADULT & FAMILY HEALTH CARE PLLC
Entity type:Organization
Organization Name:HAMBURG NURSE PRACTITIONERS IN ADULT & FAMILY HEALTH CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DNP ANP - OWNER OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:CERRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-648-3300
Mailing Address - Street 1:4535 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 705
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1860
Mailing Address - Country:US
Mailing Address - Phone:716-648-3300
Mailing Address - Fax:716-648-3322
Practice Address - Street 1:4535 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 705
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-648-3300
Practice Address - Fax:716-648-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty