Provider Demographics
NPI:1508926254
Name:WINIECKI, DENNIS G (DPM)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:G
Last Name:WINIECKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN2729213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00010254601OtherUNIVERA
NY005075131OtherBLUE CROSS
8903883OtherIHA
NY00624286Medicaid
0043055OtherGHI
005075131OtherUNITED HEALTHCARE
0043055OtherGHI
005075131OtherUNITED HEALTHCARE