Provider Demographics
NPI:1699785543
Name:STRECIWILK, CHARLES J (NP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:STRECIWILK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01302-0910
Mailing Address - Country:US
Mailing Address - Phone:413-772-8500
Mailing Address - Fax:413-772-8900
Practice Address - Street 1:340 MONTAGUE CITY ROAD
Practice Address - Street 2:FARREN CARE CENTER
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376
Practice Address - Country:US
Practice Address - Phone:413-774-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP0608OtherBC/BS MA
MA0312240Medicaid
MA25339OtherBMC HEALTHNET
MANP0608OtherBC/BS MA
MANP0608Medicare ID - Type Unspecified