Healthcare Provider Details

I. General information

NPI: 1962143651
Provider Name (Legal Business Name): JESSE KOWALEWSKI NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2095
US

IV. Provider business mailing address

9 DENNYBROOKE LN
WEST SENECA NY
14224-4755
US

V. Phone/Fax

Practice location:
  • Phone: 716-826-7000
  • Fax:
Mailing address:
  • Phone: 716-857-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349126
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: