Healthcare Provider Details

I. General information

NPI: 1235134149
Provider Name (Legal Business Name): DAVID P KOWALSKI MD FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 SOUTHWESTERN BLVD STE 104
ORCHARD PARK NY
14127-1239
US

IV. Provider business mailing address

3065 SOUTHWESTERN BLVD STE 104
ORCHARD PARK NY
14127-1239
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-3065
  • Fax: 716-677-3065
Mailing address:
  • Phone: 716-677-3065
  • Fax: 716-677-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204975
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number008329
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID P KOWALSKI
Title or Position: OWNER
Credential: MD
Phone: 716-677-3065