Active NPI
Charles August Wasicek, MD
- Rheumatology Physician
- Watertown, NY
National Provider Identifier
1619049038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 122206
- Practice address
- 145 Clinton Street
Watertown, NY 13601 - Phone
- (315) 782-5523
- Fax
- (315) 782-0549
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 122206 | NY | Primary |
Addresses
Primary practice location
145 Clinton Street
Watertown, NY 13601
Mailing address
145 Clinton Street
Watertown, NY 13601
Phone (315) 782-5523
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00875434MC | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122206 | NY | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305763200000",
"number": "1619049038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 CLINTON STREET",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "13601",
"telephone_number": "315-782-5523",
"fax_number": "315-782-0549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 CLINTON STREET",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "13601",
"telephone_number": "315-782-5523",
"fax_number": "315-782-0549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASICEK",
"first_name": "CHARLES",
"middle_name": "AUGUST",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2011-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "NY",
"license": "122206",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00875434MC",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.