Provider Demographics
NPI:1750389714
Name:PIECHOCKI, EDWARD S (PA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:PIECHOCKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1015
Mailing Address - Country:US
Mailing Address - Phone:585-786-2290
Mailing Address - Fax:585-786-2853
Practice Address - Street 1:408 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1015
Practice Address - Country:US
Practice Address - Phone:585-786-2290
Practice Address - Fax:585-786-2853
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00596-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01984752Medicaid
NYDD2100Medicare ID - Type Unspecified
NYR53947Medicare UPIN