ADAM BOGDAN LICZNERSKI MD NPI 1447229869

NPI Information

NPI: 1447229869
Provider Name: ADAM BOGDAN LICZNERSKI, MD
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
826 WASHINGTON ST
SUITE 104
WATERTOWN, NY
ZIP 13601
Phone: (315) 786-1500
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Adam Bogdan Licznerski, MD is a specialist in Watertown, NY. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. Adam Bogdan Licznerski, MD NPI is 1447229869. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

826 WASHINGTON ST
SUITE 104
WATERTOWN, NY
ZIP 13601-065
Phone: (315) 786-1500
Fax: (315) 786-2074

The enumeration date for this NPI number is 3/16/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		189322-1	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	G08406	MEDICARE UPIN
2	01680515	MEDICAID	NEW YORK
3	AA0167	OTHER	NEW YORK	GROUP NUMBER
4	BB3693	MEDICARE ID-TYPE UNSPECIFIED

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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