Provider Demographics
NPI:1942809694
Name:SOWICKI, PHILLIP JOHN (RN)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:JOHN
Last Name:SOWICKI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 INDUCON DR E
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:NY
Mailing Address - Zip Code:14132-9098
Mailing Address - Country:US
Mailing Address - Phone:716-731-2030
Mailing Address - Fax:
Practice Address - Street 1:6301 INDUCON DR E
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:NY
Practice Address - Zip Code:14132-9098
Practice Address - Country:US
Practice Address - Phone:716-731-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY475707163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse