Provider Demographics
NPI:1922212596
Name:BUKOWSKI, STANLEY LOYOLA (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LOYOLA
Last Name:BUKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:WENDE CORRECTIONAL FACILITY
Mailing Address - Street 2:3040 WENDE ROAD
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1187
Mailing Address - Country:US
Mailing Address - Phone:716-937-4000
Mailing Address - Fax:716-937-4244
Practice Address - Street 1:WENDE CORRECTIONAL FACILITY
Practice Address - Street 2:3040 WENDE ROAD
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1187
Practice Address - Country:US
Practice Address - Phone:716-937-4000
Practice Address - Fax:716-937-4244
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY163024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine