Healthcare Provider Details

I. General information

NPI: 1326439449
Provider Name (Legal Business Name): EWELINA KOBYLARZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 BROADWAY
BROOKLYN NY
11221-8872
US

IV. Provider business mailing address

6614 71ST ST
MIDDLE VILLAGE NY
11379-2118
US

V. Phone/Fax

Practice location:
  • Phone: 347-362-1712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: