Healthcare Provider Details

I. General information

NPI: 1851468094
Provider Name (Legal Business Name): PIOTR STYCZEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

440 PROSPECT AVE APT 4F
BROOKLYN NY
11215-5871
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5900
  • Fax: 718-579-4620
Mailing address:
  • Phone: 718-832-2829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number007960-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: