Healthcare Provider Details

I. General information

NPI: 1790808780
Provider Name (Legal Business Name): NANCY KOWALSKI L.P.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 SKYLINE DRIVE
RINGWOOD NJ
07456
US

IV. Provider business mailing address

409 RIVERVIEW RD
POMPTON LAKES NJ
07442-1925
US

V. Phone/Fax

Practice location:
  • Phone: 973-464-2991
  • Fax:
Mailing address:
  • Phone: 973-831-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00355800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: