Basic Information
| Provider Information | |||||||||
| NPI: | 1124157383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FREDERICK J PIWKO MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3976 LOCKPORT OLCOTT RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LOCKPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140941133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164394248 | ||||||||
| FaxNumber: | 7164394838 | ||||||||
| Practice Location | |||||||||
| Address1: | 3976 LOCKPORT OLCOTT RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LOCKPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140941133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164394248 | ||||||||
| FaxNumber: | 7164394838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 10/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | PIWKO | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 7164394248 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.