Licznerski, Adam Bogdan
Licznerski, Adam Bogdan is an individual health care provider with primary practice located at 826 Washington St Suite 104, Watertown NY 13601-4065. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Licznerski, Adam Bogdan can be contacted via phone (315) 786-1500.Contact Information
Primary practice address
826 Washington St Suite 104
Watertown NY 13601-4065
Phone: (315) 786-1500
Fax: (315) 786-2074
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 189322-1 | New York |
Profile Details
| NPI number | 1447229869 |
|---|---|
| LBN Legal business name | Licznerski, Adam Bogdan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 16th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447229869 | NPPES |
| New York | MEDICAID | 01680515 | |
| New York | Other | AA0167 |
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