Provider Demographics
NPI:1750374948
Name:KOSTEK, GARY J (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:KOSTEK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8643 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6315
Mailing Address - Country:US
Mailing Address - Phone:716-634-4133
Mailing Address - Fax:716-634-4140
Practice Address - Street 1:8643 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6315
Practice Address - Country:US
Practice Address - Phone:716-634-4133
Practice Address - Fax:716-634-4140
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006972-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC06972-6BOtherWC PROVIDER #
NY002113491OtherBC/BS PROVIDER #
NY5800965OtherGHI PROVIDER #
NY8809538OtherIHA PROVIDER #
NY911157OtherMPN PROVIDER #
NY35002855-2OtherRAILROAD MEDICARE
NY161439044OtherPRISM PROVIDER #