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NPI Code Detail

MEDICARE: MR. ANDREW JAMES FIDURKO LCSW

MEDICARE: MR. ANDREW JAMES FIDURKO LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker081157NY
21041C0700XClinical Social Worker095297NY

General Provider Information

NPI Number : 1003452939
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW JAMES FIDURKO LCSW
Provider Business Mailing Address
First Line : 110 W 6TH ST
Second Line :
City : OSWEGO
State : NY
Zip : 13126-2507
Country : US
Telephone Number : 315-349-5511
Fax Number :
Provider Business Practice Location Address
First Line : 29 E CAYUGA ST
Second Line :
City : OSWEGO
State : NY
Zip : 13126-1241
Country : US
Telephone Number : 315-326-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2019
Last Update Date : 10/16/2023

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