Provider Demographics
NPI:1851355747
Name:OSTOLSKI, MICHAEL J (FNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:OSTOLSKI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5371
Mailing Address - Country:US
Mailing Address - Phone:716-514-9355
Mailing Address - Fax:
Practice Address - Street 1:702 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5371
Practice Address - Country:US
Practice Address - Phone:716-514-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331677363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051212000052OtherFIDELIS
NY9512989OtherINDEPENDENT HEALTH
NY00026927603OtherUNIVERA
NY000560289009OtherBCBS OF WNY
NY000560289009OtherBCBS OF WNY
NYRA8263Medicare ID - Type Unspecified