MEDICARE: DR. TOMASZ WOJCIECH KOWACZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	214508	NY

General Provider Information

NPI Number	:	1063436798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOMASZ WOJCIECH KOWACZ MD

Provider Business Mailing Address
First Line	:	9805 67TH AVE APT 9C
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-4928
Country	:	US
Telephone Number	:	718-897-5061
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 WINTHROP ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-1709
Country	:	US
Telephone Number	:	718-245-2313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/06/2008

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