Provider Demographics
NPI:1235134149
Name:DAVID P KOWALSKI MD FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:DAVID P KOWALSKI MD FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-677-3065
Mailing Address - Street 1:3065 SOUTHWESTERN BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1239
Mailing Address - Country:US
Mailing Address - Phone:716-677-3065
Mailing Address - Fax:716-677-3065
Practice Address - Street 1:3065 SOUTHWESTERN BLVD
Practice Address - Street 2:STE 104
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1239
Practice Address - Country:US
Practice Address - Phone:716-677-3065
Practice Address - Fax:716-677-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204975207Q00000X
NY008329363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDC5229OtherRAILROAD MEDICARE
NYBA0381Medicare PIN