Healthcare Provider Details

I. General information

NPI: 1629298336
Provider Name (Legal Business Name): GREGORY PAUL TOCZKO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PARK ST
MALONE NY
12953-1243
US

IV. Provider business mailing address

59 MILWAUKEE ST
MALONE NY
12953-1916
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-3000
  • Fax:
Mailing address:
  • Phone: 518-353-2579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number925
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: