Healthcare Provider Details

I. General information

NPI: 1831440932
Provider Name (Legal Business Name): JOHN MULAWKA DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6763 ERIE RD
DERBY NY
14047-9670
US

IV. Provider business mailing address

6763 ERIE RD
DERBY NY
14047-9670
US

V. Phone/Fax

Practice location:
  • Phone: 716-947-2222
  • Fax: 716-947-2223
Mailing address:
  • Phone: 716-947-2222
  • Fax: 716-947-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224453
License Number StateNY

VIII. Authorized Official

Name: JOHN MICHAEL MULAWKA III
Title or Position: OWNER
Credential: DO
Phone: 716-947-2222