Healthcare Provider Details

I. General information

NPI: 1578858593
Provider Name (Legal Business Name): KATARZYNA KOCON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14732 72ND RD APT. 3C
FLUSHING NY
11367-2566
US

IV. Provider business mailing address

14732 72ND RD APT. 3C
FLUSHING NY
11367-2566
US

V. Phone/Fax

Practice location:
  • Phone: 516-849-4357
  • Fax:
Mailing address:
  • Phone: 516-849-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number642755-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: