Provider Demographics
NPI:1760936769
Name:SOBKOWIAK, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SOBKOWIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3262
Mailing Address - Country:US
Mailing Address - Phone:716-864-6129
Mailing Address - Fax:
Practice Address - Street 1:515 ABBOTT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1700
Practice Address - Country:US
Practice Address - Phone:716-828-8748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019771-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant