Physicians Practice of Eastern Niagara PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

PHYSICIANS PRACTICE OF EASTERN NIAGARA PC

Practice address

15 Elizabeth Dr
Lockport, NY 14094-5226

Phone

(716) 692-3302

Fax

(716) 213-0935

NPI assigned

Jan 13, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Ickowski

Title

Cfo

Phone

(716) 514-5501

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389571200000",
    "number": "1053733915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 NIAGARA FALLS BLVD",
            "address_2": "SUITE 208",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141202019",
            "telephone_number": "716-692-2160",
            "fax_number": "716-213-0935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 ELIZABETH DR",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140945226",
            "telephone_number": "716-692-3302",
            "fax_number": "716-213-0935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS PRACTICE OF EASTERN NIAGARA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-13",
        "last_updated": "2014-01-13",
        "status": "A",
        "authorized_official_last_name": "ICKOWSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "716-514-5501"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prashant Pendyala, MD
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• Kortnee Perry, RN
• Diana Petrizzo, RN
• Physical Rehabilitation Associate PLLC
• Marian C Pilecki, DDS
• Joanne Marie Pingtella, MA, TSHH, CCC/SLP
• Dawn M Pisarski, ANP
• Frederick J Piwko, MD
• Tracy Pixley

• Surgery Physician in Lockport, NY
• Providers in Lockport, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.