Healthcare Provider Details

I. General information

NPI: 1134199078
Provider Name (Legal Business Name): DONALD WALTER KOWALSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3043 STATE ROUTE 4
HUDSON FALLS NY
12839-9632
US

IV. Provider business mailing address

3043 STATE ROUTE 4
HUDSON FALLS NY
12839-9632
US

V. Phone/Fax

Practice location:
  • Phone: 518-747-2284
  • Fax: 518-747-2253
Mailing address:
  • Phone: 518-747-2284
  • Fax: 518-747-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number156437-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: