Jan Michal Wieckowski, M.D., PH.D.

Primary specialty

Ambulatory Fertility FacilityTaxonomy code 261QA0006X

License

123310 Issued in NY

Practice address

4332 E River Rd
Grand Island, NY 14072-1147

Phone

(716) 773-7927

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. John Michal Wieckowski Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740401538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4332 E RIVER RD",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140721147",
            "telephone_number": "716-773-7927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4332 E RIVER RD",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140721147",
            "telephone_number": "716-773-7927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIECKOWSKI",
        "first_name": "JAN",
        "middle_name": "MICHAL",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QA0006X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Fertility Facility",
            "state": "NY",
            "license": "123310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "WIECKOWSKI",
            "middle_name": "MICHAL",
            "prefix": "DR.",
            "credential": "M.D., PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Steven Michael Warden, RDN
• Jessica Waskow, LMHC
• Elena Marie Watt, PA
• Lisa Villafuerte Watt, OTR
• Susan Kathleen Wehling, DPT
• Nicole M. Wilson, C.O.T.A.
• Stacy Wilson, LMSW
• Jennifer Rose Winarski
• WJW Optometry PC
• Jennifer A Wojcik, M.A., CCC-SLP, NYSL

• Clinic/Center in Grand Island, NY
• Providers in Grand Island, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.