Provider Demographics
NPI:1275701328
Name:DENNIS G. WINIECKI
Entity Type:Organization
Organization Name:DENNIS G. WINIECKI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:WINIECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-692-1451
Mailing Address - Street 1:87 MEAD STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120
Mailing Address - Country:US
Mailing Address - Phone:716-692-1451
Mailing Address - Fax:716-692-1495
Practice Address - Street 1:87 MEAD STREET
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120
Practice Address - Country:US
Practice Address - Phone:716-692-1451
Practice Address - Fax:716-692-1495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENNIS G.WINIECKI DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-12
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN2729332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005075131OtherBLUE CROSS
NY00010254601OtherUNIVERA
NY00624286Medicaid
NY8903883OtherIHA
NY000507513002OtherBLUE CROSS DME
NY0485280002Medicare NSC