Healthcare Provider Details

I. General information

NPI: 1598300923
Provider Name (Legal Business Name): JUSTINA KOWARA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 TRAILAWAY LN
HAVERHILL FL
33417-5833
US

IV. Provider business mailing address

1121 TRAILAWAY LN
HAVERHILL FL
33417-5833
US

V. Phone/Fax

Practice location:
  • Phone: 718-427-3306
  • Fax:
Mailing address:
  • Phone: 718-427-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: