Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | ||
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 339314 | NY |
NPI | 1063616365 |
---|---|
Provider Name | Mr. Matthew D Wolanski |
First Address | Rochester, NY 14620-2733 |
Second Address | Rochester, NY 14620-2237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 06/04/2015 |