Healthcare Provider Details

I. General information

NPI: 1952396210
Provider Name (Legal Business Name): MACIEJ NOWAKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 PENNSYLVANIA AVE
BINGHAMTON NY
13903-1645
US

IV. Provider business mailing address

346 GRAND AVE
JOHNSON CITY NY
13790-2580
US

V. Phone/Fax

Practice location:
  • Phone: 607-762-2048
  • Fax: 607-762-3496
Mailing address:
  • Phone: 607-762-2048
  • Fax: 607-762-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number233376
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number233376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: