Provider Demographics
NPI:1114966009
Name:IMIOLEK, PIOTR ZBIGNIEW (MD)
Entity Type:Individual
Prefix:MR
First Name:PIOTR
Middle Name:ZBIGNIEW
Last Name:IMIOLEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAGEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-922-0180
Mailing Address - Fax:585-922-0185
Practice Address - Street 1:30 HAGEN DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-922-0180
Practice Address - Fax:585-922-0185
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207R00000XOtherTAXONOMY
NY207R00000XOtherTAXONOMY
NJI11635Medicare UPIN
NYJ400152269Medicare PIN