Organization
PHYSICIANS PRACTICE OF EASTERN NIAGARA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ICKOWSKI (CFO)
(716) 514-5501
Entity
Organization
Contact information
Practice address
15 ELIZABETH DR, LOCKPORT, NY 14094-5226
(716) 692-3302
(716) 213-0935
Mailing address
908 NIAGARA FALLS BLVD, SUITE 208, NORTH TONAWANDA, NY 14120-2019
(716) 692-2160
(716) 213-0935
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
Other
Enumeration date
01/13/2014
Last updated
01/13/2014
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