Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 381923 | NY |
NPI | 1205029097 |
---|---|
Provider Name | Nicole Niedzwiedz |
First Address | Orchard Park, NY 14127-1853 |
Second Address | Orchard Park, NY 14127-1853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2007 |
Last Update Date | 02/03/2010 |