Healthcare Provider Details

I. General information

NPI: 1881699312
Provider Name (Legal Business Name): DAVID P KOWALSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/02/2007
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: 716-712-0497
Mailing address:
  • Phone: 716-677-3065
  • Fax: 716-712-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204975
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: