Provider Demographics
NPI:1891791224
Name:CISZEWSKI, WILLIAM ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANDREW
Last Name:CISZEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 LYELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2211 LYELL AVE
Practice Address - Street 2:STE 107
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5743
Practice Address - Country:US
Practice Address - Phone:585-429-6440
Practice Address - Fax:585-429-6661
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1567841207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01135280Medicaid
NYE15607Medicare UPIN
NYDD4070Medicare ID - Type Unspecified