Provider Demographics
NPI:1134160872
Name:POWALSKI, ROBERT J JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:POWALSKI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6440 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1033
Mailing Address - Country:US
Mailing Address - Phone:716-684-5454
Mailing Address - Fax:716-685-9566
Practice Address - Street 1:3834 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1039
Practice Address - Country:US
Practice Address - Phone:716-877-1221
Practice Address - Fax:716-877-1096
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY167611207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology