NPIMap

Individual provider Active NPI

Robert Wasiczko, M.D.

  • Surgery Physician
  • Utica, NY
National Provider Identifier
1356394191
Registry record updated Oct 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
183436 Issued in NY
Practice address
1656 Champlin Ave
Utica, NY 13502
Phone
(315) 624-4090
Fax
(315) 624-4095
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 183436 NY Primary

Addresses

Primary practice location

1656 Champlin Ave
Utica, NY 13502

Mailing address

1656 Champlin Ave.
P.O.B., Suite 335
Utica, NY 13502
Phone (315) 624-4090

Other identifiers 1

IdentifierTypeStateIssuer
01246377MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060104000253 NY Practitioner - General Surgery 5193748283 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

99 E State St
Gloversville, NY 12078-1203
Phone (518) 773-5690

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
183436NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MVHS Inc CurrentSince Oct 11, 2010 Accepting new patients
Nathan Littauer Hospital Association CurrentSince Jul 17, 2016 Accepting new patients
Albany Medical College Surgery Current Accepting new patients
Albany Medical College Current Accepting new patients
Nathan Littauer Hospital Association Current Accepting new patients
Albany Medical College CurrentSince Oct 10, 2022 Accepting new patients
Albany Medical College CurrentSince Oct 10, 2022 Accepting new patients
MVHS Inc CurrentSince Oct 11, 2010 Accepting new patients
Nathan Littauer Hospital & Nursing Home CurrentSince Jul 17, 2016 Accepting new patients
Albany Medical College Surgery CurrentSince Oct 10, 2022 Accepting new patients
Mohawk Valley Surgery Group Past Accepting new patients
Toby a Taylor Past Accepting new patients
Nathan Littauer Hospital Association Past Accepting new patients

Locations

50 New Scotland Ave
#194
Albany, NY 12208

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

47 New Scotland Ave
#61
Albany, NY 12208
Phone (518) 262-5791

99 E State St
Gloversville, NY 12078
Phone (518) 773-5690

99 E State St
Ste 107
Gloversville, NY 12078
Phone (518) 773-5687

1656 Champlin Ave
New Hartford, NY 13413
Phone (315) 624-6222

2211 Genesee St
Utica, NY 13501
Phone (315) 733-7598

1676 Sunset Ave
Utica, NY 13502
Phone (315) 624-5567

1656 Champlin Ave
Ste 335
Utica, NY 13502
Phone (315) 624-4090

1656 Champlin Ave
Utica, NY 13502
Phone (315) 624-6241

Interoperability endpoints

  • Direct secure messaging: rwasiczko30633@albanymed.direct-ci.com
  • Direct secure messaging: rwasiczko.nlh@hixny.net

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 13

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475712000000",
    "number": "1356394191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1656 CHAMPLIN AVE.",
            "address_2": "P.O.B., SUITE 335",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "13502",
            "telephone_number": "315-624-4090",
            "fax_number": "315-624-4095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1656 CHAMPLIN AVE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "13502",
            "telephone_number": "315-624-4090",
            "fax_number": "315-624-4095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASICZKO",
        "first_name": "ROBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2016-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "183436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01246377",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.