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General NPI Number Information
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NPI Number | 1770578940
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Entity Type | Individual
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Provider Name | DAVID E KWIATKOWSKI MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 42 W MAIN ST
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City | OWEGO
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State | NY
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Zip | 13827-1578
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Country | US
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Telephone | 607-687-0350
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Fax | 607-687-0333
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Provider Business Mailing Address
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Address Line | 33 LEWIS RD 2ND FL
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City | BINGHAMTON
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State | NY
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Zip | 13905-5227
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Country | US
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Telephone | 607-729-8156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 139078
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License Number State | NY
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