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General NPI Number Information
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NPI Number | 1942200894
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Entity Type | Individual
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Provider Name | HENRYK PRUSACZYK MD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1072 TROY SCHENECTADY RD NEW ENGLAND LASER AND COSMETIC SURGERY CENTER
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City | LATHAM
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State | NY
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Zip | 12110-1025
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Country | US
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Telephone | 518-783-0035
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Fax | 518-786-1160
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Provider Business Mailing Address
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Address Line | PO BOX 11716
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City | ALBANY
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State | NY
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Zip | 12211-0716
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Country | US
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Telephone | 518-783-0035
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Fax | 518-786-1160
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 194956
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License Number State | NY
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