Healthcare Provider Details

I. General information

NPI: 1427099829
Provider Name (Legal Business Name): MALGORZATA MODRZEJEWSKA KORTOWSKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 LAKEVIEW AVE
CLIFTON NJ
07011-4026
US

IV. Provider business mailing address

266 LAKEVIEW AVE
CLIFTON NJ
07011-4026
US

V. Phone/Fax

Practice location:
  • Phone: 973-340-6225
  • Fax: 973-340-0665
Mailing address:
  • Phone: 973-340-6225
  • Fax: 973-340-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMA065909
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: