Healthcare Provider Details

I. General information

NPI: 1023095205
Provider Name (Legal Business Name): STEPHEN JULIAN WADOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE BOX49
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

129 BARLOW DR S
BROOKLYN NY
11234-6721
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number177699
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number177699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: