Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 288908-1 | NY |
N | 207Q00000X | Family Doctor | 288908-1 | NY |
NPI | 1255743027 |
---|---|
Provider Name | Jacob Joseph Cukierski |
First Address | Williamsville, NY 14221-7463 |
Second Address | Williamsville, NY 14221-7463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04848606 | (05) | NY |