Healthcare Provider Details

I. General information

NPI: 1699785543
Provider Name (Legal Business Name): CHARLES J STRECIWILK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MONTAGUE CITY ROAD FARREN CARE CENTER
TURNERS FALLS MA
01376
US

IV. Provider business mailing address

PO BOX 910
GREENFIELD MA
01302-0910
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-3111
  • Fax:
Mailing address:
  • Phone: 413-772-8500
  • Fax: 413-772-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number128700
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: