Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 043183 | NY |
Y | 213EG0000X | General Practice | 043183 | NY |
NPI | 1003827742 |
---|---|
Provider Name | Dr. Walter William Rostkowski |
First Address | Sayville, NY 11782-2534 |
Second Address | Sayville, NY 11782-2534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |