Healthcare Provider Details

I. General information

NPI: 1376798652
Provider Name (Legal Business Name): FALCON GROUP INTERNATIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2008
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OXFORD XING STE 1
NEW HARTFORD NY
13413-3200
US

IV. Provider business mailing address

1 OXFORD XING STE 1
NEW HARTFORD NY
13413-3200
US

V. Phone/Fax

Practice location:
  • Phone: 315-507-4751
  • Fax: 315-765-6056
Mailing address:
  • Phone: 315-507-4751
  • Fax: 315-765-6056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CHMIELEWSKI
Title or Position: OWNER
Credential: DO
Phone: 315-507-4751