Provider Demographics
NPI:1740502301
Name:WILKOWSKI, SCOTT (MPAS RPA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WILKOWSKI
Suffix:
Gender:M
Credentials:MPAS RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WINDCROFT LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9360
Mailing Address - Country:US
Mailing Address - Phone:716-681-5933
Mailing Address - Fax:
Practice Address - Street 1:297 SPINDRIFT DR STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7894
Practice Address - Country:US
Practice Address - Phone:716-631-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant