Provider Demographics
NPI:1093757072
Name:KUJAWSKI, GREGG (NP)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:KUJAWSKI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12080 COUNTY HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13775-3460
Mailing Address - Country:US
Mailing Address - Phone:607-829-6544
Mailing Address - Fax:607-829-3190
Practice Address - Street 1:12080 COUNTY HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NY
Practice Address - Zip Code:13775-3032
Practice Address - Country:US
Practice Address - Phone:607-829-6544
Practice Address - Fax:607-829-3190
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333423-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P35706Medicare UPIN
NYRB6692Medicare PIN
NY2E3071Medicare PIN