Healthcare Provider Details

I. General information

NPI: 1699941823
Provider Name (Legal Business Name): MARC S KOWALSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GREENWICH OFFICE PARK
GREENWICH CT
06831-5151
US

IV. Provider business mailing address

6 GREENWICH OFFICE PARK
GREENWICH CT
06831-5151
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-1145
  • Fax: 203-618-1721
Mailing address:
  • Phone: 203-869-1145
  • Fax: 203-618-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number50484
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: