Provider Demographics
NPI:1982150405
Name:GWIZDOWSKI, ERIC (RNFA RN FIRST ASSIST)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GWIZDOWSKI
Suffix:
Gender:M
Credentials:RNFA RN FIRST ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MONTBLEU DR
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1329
Mailing Address - Country:US
Mailing Address - Phone:716-208-1990
Mailing Address - Fax:
Practice Address - Street 1:76 MONTBLEU DR
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1329
Practice Address - Country:US
Practice Address - Phone:716-208-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY559160163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant