Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 005836-1 | NY |
NPI | 1164479150 |
---|---|
Provider Name | Mark D Wilkowski |
First Address | Williamsville, NY 14221-5906 |
Second Address | Cheektowaga, NY 14225-4018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02345444 | (05) | NY |