1922212596 NPI number — DR. STANLEY LOYOLA BUKOWSKI M.D.

Table of content: DR. STANLEY LOYOLA BUKOWSKI M.D. (NPI 1922212596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922212596 NPI number — DR. STANLEY LOYOLA BUKOWSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUKOWSKI
Provider First Name:
STANLEY
Provider Middle Name:
LOYOLA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922212596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WENDE CORRECTIONAL FACILITY
Provider Second Line Business Mailing Address:
3040 WENDE ROAD
Provider Business Mailing Address City Name:
ALDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14004-1187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-937-4000
Provider Business Mailing Address Fax Number:
716-937-4244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WENDE CORRECTIONAL FACILITY
Provider Second Line Business Practice Location Address:
3040 WENDE ROAD
Provider Business Practice Location Address City Name:
ALDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14004-1187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-937-4000
Provider Business Practice Location Address Fax Number:
716-937-4244
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  163024 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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