Individual
ROBERT WASICZKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1656 CHAMPLIN AVE, UTICA, NY 13502
(315) 624-4090
(315) 624-4095
Mailing address
1656 CHAMPLIN AVE., P.O.B., SUITE 335, UTICA, NY 13502
(315) 624-4090
(315) 624-4095
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
183436
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01246377
—
NY
Enumeration date
05/19/2006
Last updated
10/06/2016
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