Healthcare Provider Details

I. General information

NPI: 1942615919
Provider Name (Legal Business Name): MALWINA POMICHOWSKA TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 10/02/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W BIG BEAVER RD STE 200
TROY MI
48084-5283
US

IV. Provider business mailing address

136 WILLIAM ST
SPRINGFIELD MA
01105-2324
US

V. Phone/Fax

Practice location:
  • Phone: 615-570-9959
  • Fax:
Mailing address:
  • Phone: 800-218-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: