Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 180089 | NY |
NPI | 1033163944 |
---|---|
Provider Name | Thomas M Kowalak |
First Address | Grand Island, NY 14072-2193 |
Second Address | Orchard Park, NY 14127-1732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 27/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01222559 | (05) | NY |