Healthcare Provider Details

I. General information

NPI: 1063436798
Provider Name (Legal Business Name): TOMASZ WOJCIECH KOWACZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 WINTHROP ST
BROOKLYN NY
11203-1709
US

IV. Provider business mailing address

9805 67TH AVE APT 9C
REGO PARK NY
11374-4928
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-2313
  • Fax:
Mailing address:
  • Phone: 718-897-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number214508
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: