Provider Demographics
NPI:1639202476
Name:CIELOSZYK, CHESTER
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:
Last Name:CIELOSZYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NO. WASHINGTON ST.
Mailing Address - Street 2:SUITE NO. 2470
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350
Mailing Address - Country:US
Mailing Address - Phone:315-867-1465
Mailing Address - Fax:315-867-1469
Practice Address - Street 1:301 NO. WASHINGTON ST.
Practice Address - Street 2:SUITE NO. 2470
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350
Practice Address - Country:US
Practice Address - Phone:315-867-1465
Practice Address - Fax:315-867-1469
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044613-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR044613-1OtherSTATE LICENSE NO.
NYHE34228JMedicare ID - Type Unspecified