Healthcare Provider Details

I. General information

NPI: 1356581466
Provider Name (Legal Business Name): ANNA M KOWALCZYK RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BARTLETT PL
HUNTINGTON NY
11743-3702
US

IV. Provider business mailing address

PO BOX 129
WESTBURY NY
11590-0018
US

V. Phone/Fax

Practice location:
  • Phone: 516-413-1009
  • Fax:
Mailing address:
  • Phone: 516-413-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number013220
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: