| Doctor Name: | ROBERT WICKIEWICZ |
| NPI Number: | 1033100151 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 114150 |
| Business Practice Address: | 1301 River St Valatie, NY - 121849694 |
| Business Phone Number: | 5187487736 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1123, LATHAM |
| State: | NY |
| Postal Code: | 121100079 |
| Phone Number: | 8003574829 |
| Fax Number: | 5187861293 |
| NPI Enumeration Date: | 10/31/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 114150 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |