Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 171307 | NY |
NPI | 1003809393 |
---|---|
Provider Name | Peter F Kowalski |
First Address | Williamsville, NY 14221-1729 |
Second Address | Williamsville, NY 14221-1729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 05/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01169011 | (05) | NY |
E35586 | (02) |