Provider Demographics
NPI:1831440932
Name:JOHN MULAWKA DO, PC
Entity type:Organization
Organization Name:JOHN MULAWKA DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MULAWKA
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:716-947-2222
Mailing Address - Street 1:6763 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9670
Mailing Address - Country:US
Mailing Address - Phone:716-947-2222
Mailing Address - Fax:716-947-2223
Practice Address - Street 1:6763 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9670
Practice Address - Country:US
Practice Address - Phone:716-947-2222
Practice Address - Fax:716-947-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224453208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01887952Medicaid
NYH73710Medicare UPIN
NYE42296Medicare UPIN