Healthcare Provider Details

I. General information

NPI: 1417657867
Provider Name (Legal Business Name): SYLWIA DZIWIREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 FRESH POND RD
MASPETH NY
11378-3541
US

IV. Provider business mailing address

6051 FRESH POND RD
MASPETH NY
11378-3541
US

V. Phone/Fax

Practice location:
  • Phone: 718-456-0960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346756-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: