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NPI Code Detail

MEDICARE: JOHN CHARLES PEGLOWSKI

MEDICARE: JOHN CHARLES PEGLOWSKI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker073640-01NY

General Provider Information

NPI Number : 1235871252
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN CHARLES PEGLOWSKI
Provider Business Mailing Address
First Line : 2 ACADEMY ST
Second Line :
City : MAYVILLE
State : NY
Zip : 14757-1033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 60 FRANKLIN AVE
Second Line :
City : DUNKIRK
State : NY
Zip : 14048-2804
Country : US
Telephone Number : 716-363-3550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2022
Last Update Date : 08/15/2022

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