Provider Demographics
NPI:1902036544
Name:NOWAKOWSKI, GARY (CRC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:NOWAKOWSKI
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 UNION RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2305
Mailing Address - Country:US
Mailing Address - Phone:716-783-0407
Mailing Address - Fax:
Practice Address - Street 1:4429 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2305
Practice Address - Country:US
Practice Address - Phone:716-783-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00006045390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program