Healthcare Provider Details

I. General information

NPI: 1992813828
Provider Name (Legal Business Name): ADAM S KOTOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 PARK CLUB LN SUITE 200
WILLIAMSVILLE NY
14221-5269
US

IV. Provider business mailing address

3041 ORCHARD PARK RD STE C
ORCHARD PARK NY
14127-1238
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-3340
  • Fax: 716-634-3350
Mailing address:
  • Phone: 716-674-3104
  • Fax: 716-674-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number249101
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number249101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: