Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N004313-1 | NY |
NPI | 1104823426 |
---|---|
Provider Name | Thomas M Pieklo |
First Address | Hornell, NY 14843-1614 |
Second Address | Hornell, NY 14843-1614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 27/08/2007 |