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Individual

ADAM BOGDAN LICZNERSKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
826 WASHINGTON ST, SUITE 104, WATERTOWN, NY 13601-4065
(315) 786-1500
(315) 786-2074
Mailing address
826 WASHINGTON ST, SUITE 104, WATERTOWN, NY 13601-4065
(315) 786-1500
(315) 786-2074

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
189322-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01680515
NY
01
AA0167
GROUP NUMBER
NY
Enumeration date
03/16/2006
Last updated
07/08/2007
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